HARCATUS HEAD START CHILD’S FILE CHECKLIST Forms should be placed in the files in the following manner.
Timeline or
event
Gray Folder-Enrollment
Orange Folder-Education
Enrollment Head Start Child Enrollment Form
Initial Home ODJFS Child Enrollment & Health Initial Home Visit Report
Visit
Information
ECDHS109
Family Agreement
Kindergarten Transition Parent
Attendance Agreement
Survey (before)
Within 30 days
Within 45
days
copy of Birth Certificate
copy of Social Security Card
ASQ-3
Articulation Screener
Custody Documents
Home-School Correspondence
ECDHS127
Change of Status
Attendance Referrals
Parent/Guardian Refusal for
Immunizations
Conference Report ECDHS113
(initial section completed)
Conference Reports ECDHS113
(mid-year section completed)
Kindergarten Transition Info.
Checklist
For IEP students, print GOLD
Individual profile and GOLD
observations
Conference Reports ECDHS113
(final home visit section)
Kindergarten Transition Parent
Survey (after)
If Needed Home Visit Report
ECDHS117
Parent Involvement in Education
Sheets ECDHS124
Field Trip Permission Slips
ECDHS104
Anecdotal Observation Booklet
Oct.-Nov or
within 3 mo’s
by Feb.
28/within
6 months
May-June/at
8 months
As Needed
or filed at
year’s end
Green Folder-Health
Parent Health Contract
Health History
HIPAA Receipt Notice
Purple Folder-Family Services
Home Visit Report
Family Partnership Agreement
Family Goal Sheet
Referral Forms
Parent Interest Survey
Medical Statement
Dental
Hearing Screening
Vision Screening
Home Visit Report
Home Visit Report
Home Visit Report
Child Observation Form
Incident Reports
Request for Admin. of Medication
Child Medical/Physical Care Plan
Medication Error Form
Treatment Letter
Hearing/Vision Referral Form
Parent/Guard. Refusal for FollowUp Services
Yellow Folder – Transition
Place copies for transition here as
documents are received.
· Birth Certificate
· Social Security Card
· Immunization Record
· Custody Papers
· Health History
· Medical Statement Form
· Immunization Record
· GOLD (Winter Data)
· Hearing & Vision Screening
· Dental
Red Folder – Social-Emotional-Behavioral/IEP/CSP
ASQ-SE (Completed on ALL children within 45 days from enrollment)
IEP/CSP Process :
· IEP File Review Documentation Form (stapled to front of red file of
Social/Emotional/Behavioral Referral Process :
children with LEA referral) ECDHS611
· Consent to Release Info. HSFCP010 sent to Dis./Prev./MH Mgr required to
· Screening Permission Slip ECDHS600
start S/E/B Referral process
· Consent for Observation ECDHS801 sent to Dis./Prev./MH Mgr required to · Home Visit Permission Slip ECDHS601
· Special Needs Home Visit Report ECDHS602
start S/E/B Referral process
· LEA or Service Provider Cover Letter ECDHS603
· Social/Emotional/Behavioral Referral ECDHS800 & 800A completed by
staff/parent; Signed by Teacher sent to Disabilities/Prev./Mental Health Mgr · Referral for Evaluation (PR-04)
· Parent Consent for Evaluation (PR-05 completed with packet for New
· Child Mental Health Observation – ECDHS 802 & 802A
Philadelphia LEA School District ONLY – DO NOT use with other LEAs
· Child Intervention Plan - ECDHS805
·
Consent for Evaluation ECDHS607
· Family Recommendation Plan – ECDHS806
·
Consent to Release Information HSFCP010
· Family Recommendation Plan Update – ECDHS 806A
· Parent Information ECDHS604
As needed:
· Evaluation Team Report (Part A)
· Behavior Observation Form – ECDHS 804
· Letter of Response ECDHS 605
· Behavior Assessment Instructions/Form – ECDHS 804A & 804B
· Referral Information
· Behavior Baseline Tracking Chart Instructions Form – ECDHS 804C
· Notification of IEP Meeting ECDHS609
· Intervention Tracking Chart – ECDHS 807
· MFE/ETR
· IEP
· Individualized Instruction Sheet ECDHS612a
· Special Needs Conference Report ECDHS613
September
October
November
December
January
February
March
April
May
FA monthly file
review dates
ECDHS119
REV 6/13