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 / Green Folder-Health / Purple Folder-Family Services
Enrollment / Head Start Child Enrollment Form
Initial Home Visit / ODJFS Child Enrollment &HealthInformation
Family Agreement
Attendance Agreement / Initial Home Visit Report ECDHS109
Kindergarten Transition Parent Survey (before) / Parent Health Contract
Health History
HIPAA Receipt Notice / Home Visit Report
Family Partnership Agreement
Family Goal Sheet
Referral Forms
Parent Interest Survey
Within 30 days / Medical Statement
Within 45 days / copy of Birth Certificate
copy of Social Security Card / ASQ-3
Articulation Screener / Dental
Hearing Screening
Vision Screening
Oct.-Nov or within 3 mo’s / Conference Report ECDHS113 (initialsection completed) / Home Visit Report
by Feb. 28/within
6 months / Conference Reports ECDHS113 (mid-year section completed)
Kindergarten Transition Info. Checklist / Home Visit Report
May-June/at 8 months / For IEP students, print GOLD
Individual profile and GOLD observations
Conference Reports ECDHS113 (final home visit section)
Kindergarten Transition Parent Survey (after) / Home Visit Report
As Needed or filed at year’s end / Custody Documents
Home-School Correspondence ECDHS127
Change of Status
Attendance Referrals
Parent/Guardian Refusal for Immunizations / If Needed Home Visit Report ECDHS117
Parent Involvement in Education Sheets ECDHS124
Field Trip Permission Slips ECDHS104
Anecdotal Observation Booklet / 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 Follow- Up 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 children with LEA referral) ECDHS611
·Screening Permission Slip ECDHS600
·Home Visit Permission Slip ECDHS601
·Special Needs Home Visit Report ECDHS602
·LEA or Service Provider Cover Letter ECDHS603
·Referral for Evaluation (PR-04)
·Parent Consent for Evaluation (PR-05 completed with packet for New Philadelphia LEA School District ONLY – DO NOT use with other LEAs
·Consent for Evaluation ECDHS607
·Consent to Release Information HSFCP010
·Parent Information ECDHS604
·Evaluation Team Report (Part A)
·Letter of Response ECDHS 605
·Referral Information
·Notification of IEP Meeting ECDHS609
·MFE/ETR
·IEP
·Individualized Instruction Sheet ECDHS612a
·Special Needs Conference Report ECDHS613
Social/Emotional/Behavioral Referral Process:
·Consent to Release Info. HSFCP010 sent to Dis./Prev./MH Mgrrequired to start S/E/B Referral process
·Consent for Observation ECDHS801 sent to Dis./Prev./MH Mgr required to start S/E/B Referral process
·Social/Emotional/Behavioral Referral ECDHS800 & 800A completed by staff/parent; Signed by Teacher sent to Disabilities/Prev./Mental Health Mgr
·Child Mental Health Observation – ECDHS 802 & 802A
·Child Intervention Plan - ECDHS805
·Family Recommendation Plan – ECDHS806
·Family Recommendation Plan Update – ECDHS 806A
As needed:
·Behavior Observation Form – ECDHS 804
·Behavior Assessment Instructions/Form – ECDHS 804A & 804B
·Behavior Baseline Tracking Chart Instructions Form – ECDHS 804C
·Intervention Tracking Chart – ECDHS 807
FA monthly file review dates / September / October / November / December / January / February / March / April / May

ECDHS119 REV 6/13