Performance Indicator Checklist For Teachers Template
ADVERTISEMENT
1HEALTH/NUTRITION AREA CHECKLIST
Head Start
LEFT SIDE
SITE VISIT
REVIEW
FOLLOW-UP
CLOSURE
DATE:
FORMS
STAFF:
CONSENT FORM A
CONSENT FORM B
CONSENT FORM C
(if applicable)
CONSENT FORM D
BLOOD PRESSURE CONSENT
(if applicable)
CHILD HEALTH HISTORY
PROMIS NUTRITIONAL INFORMATION
GROWTH CHARTS (Due 10/31 & 3/31)
REFERRAL FOR NUTRITION
(From Nutritional Information)
REFERRAL FOR NUTRITION
(From Growth Chart)
Key:
1 Form is in place and complete
9
Expired Form/ Not current
2 Form is Missing
10
Not Applicable
3 Form not in Proper Sequence
11
Missing Date
4 Form is Missing Center Manager’s Signature
12
Follow-up Needed
5 Form is Missing Family Advocate’s Signature/
13
Missing Family Identification Number
Initials
6 Form is Missing Head of Household’s Signature/
14
Provider Signature Missing
Initials
7 Incomplete/Information Missing
15
Purpose of entry not identified/
highlighted
8 Information not inputted into PROMIS database
Health/Nutrition 2010
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business