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Head Start forms descriptions for these forms. (June 2010)

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Administration

Fiscal Management

Approval for Meals and Refreshments

Child Care Advance OHSA

Long Distance Log

Material Supply Request Form

Material Supply Request Short Form

Parent Club Reimbursement Deposit

Parent Travel Cash Advance

Personal Travel Statement

Petty Cash Verification

Property Receipt

Purchase Order for Health Services (Follow-up)

Purchase Order for Health Services (Initial Exam)

Receipt Parent Travel & Childcare

Reimbursement Request: Non-Travel

Travel Authorization

Travel Reimbursement Request

Communication

Fax Coversheet

Letterhead

Management Team Meeting Minutes

Weekly Center Staff Meeting Minutes

Human Resource Management

Accident Report - Employee

Accident Report - Employee No Medical Treatment

Accident Report - Volunteer

Applicant File Form

Application for Employment

Bloodborne Pathogen Incident – Accident Report

Bloodborne Pathogen Training and Hep B Vaccination

Employee Initial Physical Exam Letter

Leave Request Form

Orientation Checklist Adjunct Employee

Orientation Checklist New Employee Orientation Checklist New Teacher/Home Visitor

Performance Evaluation 90 Day

Performance Evaluation 120 Day Performance Evaluation 120 Day Teacher Assistant

Performance Evaluation Teacher Assistant/Classroom Aide

Performance Evaluation Management Staff Performance Evaluation Cook 120 Day

Performance Evaluation Nutrition Aide 120 Day

Performance Evaluation Teacher/Home Visitor

Plan of Assistance Practicum Student Orientation Checklist and Contact Information

Resource Timesheet

Staff and Volunteer Health Self-Appraisal

Staff Time Report

Standards of Conduct

Training and Development

Education Funding Agreement

Individual Staff Training Record Mentor -Teacher Observation Note Training Attendance Record

Quality Assurance

Governance

Community Grievance

Director’s Report to Grantee Board

Supervision and Monitoring

CACFP Site Monitoring Log

Classroom Health, Nutrition and Safety Inspection

Comprehensive Staffing Form

Follow-up on File Review

Self-Assessment Checklist

Teacher Observation Teacher Observation with Teacher Assistant Weekly Center Cleaning Report

Reporting

CACFP Cook Monthly Report to Nutrition Manager

Classroom Monthly Attendance

Classroom Verification of Attendance

End-of-Year Checklist to Education Supervisor

Home Visit Tracking to Education Supervisor

Manager’s Monthly Report to Director Monthly Report Meals served AM Monthly Report Meals served PM

Monthly First Aid Supplies Report to Fiscal Manager

Monthly Report to Disabilites/Mental Health Manager

Monthly Report to Family & Community Partnership Manager

Monthly Report to Fiscal Manager

Monthly Report to Health & Nutrition Manager

Monthly Report to Education Supervisor

Monthly Safety Report to Education Supervisor

Student Accident Report Weekly Center Cleaning Report to Health and Nurition Manager

Weekly Classroom Cleaning Report to Education Supervisor

Facilities Management and Maintenance

Link Text

ERSEA / Student Records

Authorization for Release of Information

Authorization to Act as Parent

Checklist of Enrollment Forms and Materials Checklist for Head Start Health Requirements

CACFP Enrollment Baker

CACFP Enrollment Baker Spanish

CACFP Enrollment Elgin

CACFP Enrollment Elgin Spanish

CACFP Enrollment La Grande

CACFP Enrollment La Grande Spanish

CACFP Enrollment Union

CACFP Enrollment Union Spanish Child File Table of Contents

Child Health History

Child Oral Health Assessment Child Physical Exam

Directions for Transfer of Records Field Trip Parent Permission

Head Start Application

Head Start Application Spanish

Head Start Enrollment Demographics

Permanent Student Record Release of Sharing Nutritional Information WIC

Student Withdrawal Form Questionnare- Anemia

Child Health and Development

Education

Activity Format Sheet

Additional Home Visit

Anecdotal Record Anecdotal Record Code Descriptions

Child File Table of Contents

Child Release and Emergency Contact

Classroom Outcomes Plan Food Blood Glucose Diary Head Start School District Transition Plan Kindergarten Transition Plan Tracking Lesson Plan Checklist and Curriculum Guidelines Lesson Plan Curriculum Key and Color Code Returning Student Transition Plan Tracking

Disabilities

Disabilities Table of Contents Disabilities Services IFSP Manager Tracking IMESD Reffal Form Monthly Report to Disability & Mental Health Manager Service Provider Log Screening Results-Hearing Screening Results-Vision

Mental Health

Child Observation Staffing Notes Child Behavior Plan Confidential Reporting Form Information for filling out Mental Health Provider Log Individual Child Observation Notes Mental Health Classroom Observation Mental Health Provider Log Form Mental Health Referral Consent Form Monthly Report to Disability & Mental Health Manager

Notice of Child In Protective Custody

Parent Permission for Individual Child Observation

Parent Permission for Play Group Participation

Play Group Tracking Play Group Permission Form Protected Child Agreement Staff Observation Evaluation Recommendation

Health

Allergy Induced Aniaphylaxis Protocol Asthma Protocol

Authorization For Release of Information Checklist for Head Start Health Requirements

Child Health Care Provider Form

Child Health History Child Health History for Demographics

Child Oral Health Assessment

Child Physical Exam

Classroom Summary Allergies and Medications

Consent for Well Child Screening Diabetes Protocol

Food and Blood Glucose Diary Health Expectations Contract Lead Test Refusal

Medication Administration/Parent Update

Medication Authorization Medication Log Questionnaire - Lead English Questionnaire - Lead Spanish Seizure Health Care Plan Sickle Cell Anemia Protocol

Nutrition

CACFP Enrollment Form English CACFP Enrollment Form Baker City CACFP Enrollment Form Elgin CACFP Enrollment Form La Grande CACFP Enrollment Form Union

CACFP Enrollment Form Spanish CACFP Enrollment Form Baker City Spanish CACFP Enrollment Form Elgin Spanish CACFP Enrollment Form La Grande Spanish CACFP Enrollment Form Union Spanish

CACFP Recipe – Combination Foods

CACFP Recipe Crediting Worksheet Child Nutrition & Activity Assessment Parent Letter Classroom Health, Nutrition, and Safety Inspection

Child Nutrition and Activity Assessment Child Nutrition and Activity Assessment Spanish Child Nutrition and Activity Teacher Observation Instructions for WIC forms Kitchen Preparation End of the Year Medical Statement for Altered Portions

Medical Statement for Food Substitutions

Monthly Report for Meals Served AM

Monthly Report for Meals Served PM Parent Request for Altered Portions

Posted Food Restrictions

Questionnaire - Anemia

Religious Statement Food Substitution Special Diet Daily Substitutions AM Special Diet Daily Substitutions PM WIC Participant Summary Request WIC Release for Sharing Nutritional Information

Family and Community Partnerships

Family Services

Family Crest

High School Equivalency Assistance Request Parent Classroom and Volunteer Orientation

Parent Center Committee

Fundraising Approval Form

Parent Attendance Log

Parent Center Committee Agenda Format

Parent Center Committee Report to Policy Council

Parent Training Plan

Volunteers

EOU Conditions of Volunteer Service Non-Federal Resource Voucher Parent and Volunteer Orientation Practicum Student Orientation Checklist and Contact Information Practicum Student Checklist Summary - Miscellaneous In-Kind

Summary of Parent Volunteer Hours Volunteer Orientation Checklist and Contact Information

Volunteer Sign-in Sheet - Miscellaneous Volunteers

Volunteer Sign-in Sheet - Parent Classroom

Volunteer Survey

ontact Information

Eastern Oregon Head Start

One University Boulevard

Ackerman Hall Room 016

La Grande, OR 97850

Phone: 541-962-3506

E-Mail: jgoodric@eou.edu

Contacts at Head Start

Eastern Oregon University is a member of the Oregon University System

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