Napa County /

Healthy Environment Practicum Checklist

Candidate’s Name: / Home Phone:
E-mail:

Your practicum must be submitted to the Napa County BTSA New Teacher Support Specialist as a condition of the program certifying your completion of program requirements for a Clear (Level II) Credential. A complete practicum indicates mastery of “Creating a Supportive and Healthy Environment for Student Learning” (Standard 18) as described in the Standards of Quality and Effectiveness for Professional Teacher Induction Programs. Each item must be initialed either by your Support Provider or a Site Administrator and requested documentation attached. The documentation should be numbered to correspond to the item number on this checklist.

Program
Initials / SA
Initials / Induction Element / Activity
Health b; K-12: d, ii / 1.  Ensure an orientation from your Site Administrator. Provide your Site Administrator with the attached “Site Administrator Site Orientation Checklist” for ideas. Get his/her initials at left.
Program
Initials / SP
Initials / Induction Element / Activity
Equity, a, f;
Health
a, b, d, e;
EL d;
Special Pops. c / 2.  Walk your classroom with your Support Provider, then on the attached Classroom Layout, draw your classroom including furniture. On the layout, identify:
q  The placement of seating for special populations’ students (EL, GATE, special education).
q  The location of the posting of the “School Emergency Response Guide.”
q  The location of the posting of emergency evacuation plans.
q  The location of the “Community Resource Referral Guide.”
q  The location of the posting of the “Communicable Diseases Guidelines.”
q  The location of the posting of your classroom or school-wide discipline plan, rewards and consequences.
Attach to the layout:
q  A written rationale for furniture placement, including:
q  Ways the room arrangement creates a safe and accident-free environment.
q  Ways the seating of special populations’ students promotes their physical, cognitive, emotional and social well-being.
q  A copy of your discipline plan.
q  A list of accident hazards that you have identified and either fixed or reported to your site administrator.
q  If the environment is not accident free, reflect on practices that need to be in place, or if these are in your control, provide an action plan for steps within your control for putting the practices in place.
q  A reflection on ways these documents and strategies contribute to accident prevention strategies within the classroom and the school site.
Health a, d / 3a. Emergency Backpack: Inventory the contents of your classroom emergency backpack and notify your site administrator of items that need replacement. Attach the inventory and note the location of the backpack or
3b. Request of your site administrator and School Site Council/parent club that your classroom have a fully-equipped emergency backpack; provide a list of materials you believe it should contain (find complete list at www.ncoe.k12.ca.us (Teachers—BTSA—Forms)) and attach a copy of your memo to the site administrator.
Health a, d / 4a. Emergency Barrel: Request a list of the contents of the school emergency barrel from your site administrator. Attach the list and note the location of the nearest barrel or
4b. Request of your site administrator and School Site Council/parent club that your school have a fully-equipped school emergency barrel; provide a list of materials you believe it should contain (find complete list at www.ncoe.k12.ca.us (Teachers—BTSA—Forms)) and attach a copy of your memo to the site administrator.
Health c / 5. Create and attach a list of students who have emergency medications on site and the location of the medications, or attach copies of their health cards.
Program
Initials / SA
Initials / Induction Element / Activity
Health e / 6. Students screening is/was scheduled for students at your school on (date/month/year):
Vision:______
Hearing:______
Scoliosis/diabetes:______
Health d, e, g &
Sp. Pops. b / 7. Find the following school-wide emergency resources, and complete the 3 sections below:
q  Should a student or staff emergency arise, staff emergency personnel contacts are located (where?):______
q  School guidelines for using outside speakers. Forms for requesting permission to use an outside speaker are located (where?): ______
q  Student accident procedures. Accident report forms are located (where?): ______
Tech. f; Health c, e, g;
EL k / 8. Read and highlight the “Communication” tips sheet attached. Discuss appropriate communication strategies with your Support Provider. Attach the highlighted document.
Health e, c / 9.  Participate in at least one locally offered health-related workshop. (Opportunities vary from year-to-year and will be e-mailed to participants.) Attach the completion certificate, agenda or other evidence of participation.
Health d, e, g / 10.  From your district’s website, read your district’s policies* on safety planning (0450, 3516), drugs and alcohol (3513, 4020, 5131), hate behavior (5145), universal precautions (4119, 5141), harassment (0410, 4119), administration of medication (5141) and wellness (5030).
q  Copy sections that are relevant to your teaching assignment to a new document
q  Discuss these sections with your Support Provider or site administrator.
q  Attach the new document.
Health e, f, g / 11.  Explore the Health Framework (www.cde.ca.gov) by reading, at minimum, Chapters 1 and 3, including the “Scope and Sequence of Health Education” for your grade level span. From these sections of the Framework, or others if desired, determine the health/safety responsibilities related to your teaching assignment. Download relevant segments to a new document or print the chapters and highlight your responsibilities. Attach the document you create.
Health g / 12.  Download the booklet “Child Abuse Educator’s Responsibilities” at www.safestate.org/documents/ca_ca_educ_resp_ada_2007_wo_cover.pdf and highlight state and federal reporting requirements related to child abuse and neglect that apply to you. Attach the highlighted document and note the location of the Child Protective Services forms here: ______
Health g / 13.  Access the Child Abuse Prevention Council of Sacramento’s website (www.capcsac.org/child_prev/). Review the resources, download one helpful resource and attach it.
Health e / 14.  Select one of your focus students and:
q  Complete the survey on pages 6 & 7 of the “Our Children, Our Future: Parent, Educator and Community Action Guide” about that student to the best of your knowledge.
q  Read and highlight the full document with that student in mind.
q  Discuss your thoughts with your Support Provider.
q  Based on your shared ideas, communicate with the parent of that student about his/her assets. If appropriate, you may also want to address ways the parent could support the further development of the student’s assets.
q  Attach your communication to the parent.
Health c, e, g / 15.  Read the school’s annual “Notice to Parents and Guardians” (available from the school office) regarding state and local policies about family life and sex education, procedures for notifying parents, and parental rights regarding instruction in health. Highlight interesting findings. Discuss the learnings with your Support Provider and attach the highlighted document.

*Directions for finding NVUSD policies: Go to www.nvusd.k12.ca.us; Select “District Information” from the banner at the top; On the page that comes up, select “Board of Education;” On the left of that page under “Links”, click on “Board Policies Online” (Note and use the User Name and Password provided under “Links.”); From there, you can access specific policies by number.

Classroom Layout Draw your classroom, including furniture. Identify the features requested in Health Practicum Item 2.
(Induction Elements 17a, 17f, 18a, 18b, 18c, 18d, 18e, 19d, 20c)

(Include “communications” tip sheet (pink)
Sample Site Administrator Orientation Checklist

Participating Teacher: ______School:______

Site Administrator (signature indicates completion): ______

Site Orientation Topics
Staff Information:
q  District Goals
q  District Literacy Initiative (Target)
q  School Personnel
q  School Office
q  Employee Information
q  Communication with Colleagues
q  Health Education
q  Staff Responsibilities
q  Evaluation
q  Office Machines and Equipment
q  School Rules/Discipline Policy
q  Leadership
q  Yearly Calendar
q  Site contact (any question) / School Information
q  School Vision and Values
q  School Policies
q  Homework Plan
q  Behavior Management System
q  Room Environment
q  Student Content Standards
q  Instructional Materials
q  Back-to-School Event/Open House
q  Lesson Plans
q  Technology & Equipment
q  Telephone Guidelines
q  Safety Procedures
q  Hours to be on campus
q  Testing Data
q  Cumulative Records
New Teacher Site Meeting Topics:
q  Interventions for at-risk students
q  Parent Conferences/Report Cards
q  Classroom Management
q  Teaching Context Information / q  Expectations for Bulletin Boards
q  Instructional Planning Time
q  Communication with Parents
q  Translating Services
Standard 15: Core Academic Content and Subject Specific Pedagogy
Teacher informed about:
q  Grading and Reporting Policies
q  Training in the Use of Electronic Report Cards
q  Guidelines for Communicating with Parents
q  State Adopted Curriculum
q  Core Texts and Teachers’ Manuals
q  EL Supplements
q  Technology Supplements
q  Supplements for Special Populations/Universal Access
q  Differentiating Instruction
q  Literacy Initiative
q  District Assessment Information
Standard 16: Using Technology to Support Student Learning
Teacher informed about:
q  Teacher Internet Use Agreement
q  Technology-enhanced Lesson
q  Power Point Lesson or Presentation
q  Teacher Use of Technology Software/Hardware
q  Using District E-mail. Username ______Password ______
q  Technology Available for Use On Site
Standard 17: Supporting Equity, Diversity, and Access to the Core Curriculum
Teacher informed about:
q  Student Population Demographics
q  Information on Sexual Harassment
q  Reporting Procedures for Sexual Harassment and Child
Standard 18: Creating a Supportive and Healthy Environment
Teacher informed about:
q  Student Study Team Meetings
q  Emergency Drills
q  Crisis Response Plan
q  Referrals for Speech, Educational Assessment, Vision and Hearing Screening
q  Health Curriculum Responsibilities / q  Responding to Emergency Health Situations
q  Guidelines for Accessing and Using OutsideS
q  Anti-bullying/harassment Lessons
q  Emergency Numbers
q  Community Resource Guide
Standard 19: Teaching English Learners
Teacher informed about:
q  Instructional Program for English Learners
q  First Language Support Services and Translation Procedures
q  State-Adopted Academic Content Standards, ELD Standards, and the Assessment Calendar (Has copies of all)
q  CELDT Results for English Learners
Standard 20: Teaching Special Population
Teacher informed about:
q  Site Resources Available to Meet the Needs of Special Populations Students (Special Education, GATE)
q  Legal Requirements of IEP
q  Need to Attend an IEP Meeting
q  Need to Participate in a Student Study Team Meeting
q  Issues and Procedures on Retention and Promotion of Students
q  Positive Behavior Support Strategies Used in Classroom
q  Conflict Management Strategies Incorporated into Classroom

Revised June 9, 2008 Page 6 of 6