Crown Copyright materials adapted, translated and reproduced with the permission of the Controller of Her Majesty’s Stationery Office. This form has been produced from the olm CareFirst System.
Looking After Children
Part One of the Essential Information Record (Questions 1-22) provides baseline information for carers in an emergency. All these questions must be answered before any child/young person can be left in a placement. The information should be given to carers with the Placement agreement. Wherever possible, Part Two (Questions 23-63) / ESSENTIAL INFORMATION RECORD: PART 2
Personal information for a child or young person looked after by a Local Authority
Wherever possible, Part Two (Questions 23-63) should be / Forenames
completed before the child is looked
after. In the case of an emergency admission it should be completed as / Family Name
soon as possible thereafter. Both
parts of the Essential Information Record should be updated before / Gender / Male / Female
each Review, on a supplementary
sheet if necessary. Copies should be sent to residential workers and carers. / Date of Birth / Day / Month / Year
A further copy should be kept on the child/young person’s file.
903 P E R S O N A L D E T A I L S
The Looking After Children Management and ImplementationGuide explains how responses to highlighted questions can be used to. / 23 / Where is the BirthCertificate Kept?
complete the SSDA903 statistical
returns for the Department of Health / Please tick box if the certificate has been seen by a Social Worker
24 / Place of Birth / Town/Village
Country
25 / Nationality
Local Authorities which have accepted children who are refugees must ensure that they visit the Home Office with an / Please give details of immigration status if applicable:
interpreter, a social worker and a solicitor
as soon as possible after their arrival in the UK. Local Authorities will need to keep / Asylum seeking / Exceptional leave to remain
records of Home Office registration
numbers in order to prove a child’s existence for the purpose of claiming / Refugee Status
government grants.
Home Office Registration Number
26 / Is the young person a parent? / Yes / No /
If yes, does s/he have parental responsibility? / Yes / No
Where does the young / With the young person / With other relatives
person’s child live? / Looked After by LA / Adopted
Other (specify)
Child’s Name
Date of Birth / Day / Month / Year
Is there a Social Services File on the Child / Yes / No
File Number and Location
This form contains confidential information which should not be shared without the agreement of the responsible Authority and the persons concerned.
Looking After Children Essential Information Record Part Two 2
H E A L T HA process of replacing existing NHS numbers starts in mid1995 / 27 / Child/young person’s NHS Number
Issued before July 1995
Issued from July 1995
Where is the card kept?
28 / Who holds the Personal Child health Record (PCHR)?
Please tick box when a note has been made on the PCHR indicating
that an Essential Information Record has been completed
Check with your health authority as there may be local variations for some / 29 / Immunisations / Age
immunisations. They will also be able to tell you if any subsequent changes / Due / Given
have been made to this table. / At two months / Diptheria/Tetanus/Pertussis / months
1Hib is the immunisation against meningococcal meningitis. If the child / At two months / Polio / months
has not received Hib immunisation before one year of age, a single dose / At two months / Hib1 / months
of Hib may be given between one and four years. / At three months / Diptheria/Tetanus/Pertussis / months
2If not yet given. / At three months / Polio / months
3Not necessary if / At three months / Hib1 / months
Measles/Mumps/Rubella already given. / At four months / Diptheria/Tetanus/Pertussis / months
4BCG is the immunisation against tuberculosis. In some health / At four months / Polio / months
authorities it is only administered to people who are considered to be at / At four months / Hib1 / months
particular risk. / Between 12 and 18 / Measles/Mumps/Rubella / months
Between 4 and 5 years / Diphtheria/Tetanus/Polio / months
Between 4 and 5 years / Measles/Mumps/Rubella2 / months
Between 10 and 14 years / Rubella3 / months
Between 10 and 14 years / Heaf Test and BCG4 / months
Between 15 and 18 years / Tetanus and Polio / months
Any other immunisations? / Yes / No
Please Specify:
Please indicate medical reasons for any omissions:
30 / Has the child/young person been tested for sickle cell disorders
(eg thalassaemia, sickle cell anaemia)?
Yes / No / No Information
If yes, what was the result?
Please tick the left-hand boxes as appropriate and, where known / 31 / Childhood Illnesses:
give age when condition was diagnosed in the right hand boxes. / Measles / German Measles (rubella)
Chicken Pox / Mumps
Whooping Cough
Any other significant illnesses? / Yes / No
Please Specify:
Looking After ChildrenEssential Information Record Part Two 3
32 / Has the child/young person been in contact with Tuberculosis?Yes / No / No information
Does s/he belong to a family with a history of the disease?
Yes / No / No information
Under the Children Act 1989, local authorities are required to keep registers / 33 / Is the child/young person’s name on the register of disabled children
of children with disabilities living in their area. Registration is a voluntary procedure: / Yes / No
parents are not obliged to agree to their
children being registered, nor are services dependent on registration. The purpose of the register is to coordinate / 34 / Does the child/young person have a condition requiring corrective surgery or orthodontic treatment (e.g. squint, crooked teeth, cleft palate)?
the services offered by health, education
and social services for children with disabilities, and make it easier to plan and / Yes / No
monitor what is provided.
If yes, please give further details including current treatment plan:
Please give details of all significant accidents and injuries, not only recent incidents that still require treatment. / 35 Has the child/young person had any significant accidents and injuries? If
so, please give details and indicate if further treatment will be required:
In certain cases you may need to continue the hospital record on a / 36 / Periods in Hospital:
supplementary sheet. / Hospital / Reason / Consultant
From
To
From
To
From
To
From
To
From
To
From
To
From
To
From
To
From
To
Looking After ChildrenEssential Information Record Part Two4
E D U C A T I O N
Please list all formal educational provision made for the child/young / 37 / Education provision and schools attended:person; as well as schools attended, also include nursery and pre-school provision, and periods of home tuition. / Name / Type / Reason for Leaving
From
To
From
To
From
To
From
To
From
To
From
To
From
To
From
To
From
To
From
To
The Education Act 1993 introduces new arrangements for the assessment of / 38a / Does the child/young person have an individual education plan?
children with special educational needs. An individual education plan (IEP) sets / Yes / Pending / No
targets for a child to achieve, and a date
for review to see what progress has been made. A statutory assessment is a detailed examination of a child’s / 38b / Has the child/young person been made the subject of a statement of special educational needs?
special educational needs. It may lead to a statement. A statement of special / Yes, still extant / Yes, but now expired / No assessment or statement
educational needs is a document that
sets out a child’s special needs and the special help that s/he should receive. / Pending / Statutory assessment only
A transition plan is drawn up at the first
annual review of a statement after the child’s fourteenth birthday. It is / For children and young people aged 14 and over:
important in preparing for his/her move to adult life. / 38c / Has a transition plan been made? / Yes / Pending / No
39a / School leaving qualifications: (eg: GCSE, NVQ, BTech, City & Guilds)
Date / Qualification / Subject / Grade
Questions 39-44 are to be completed from the end of the young person’s
GCSE year (ie at 16+).
Looking After ChildrenEssential Information Record Part Two 5
39b / Further education qualifications (eg A Levels):Date / Qualification / Subject / Grade
Please include any courses that the young person has begun and not / 40 / Other courses and training undertaken:
completed.
41 / Achievements in sport, music, drama, etc:
42 / Who holds the young person’s Record of Achievement?
43 / Young person’s National Insurance number:
Please include periods of unemployment. / 44 / Employment since leaving school:
Occupation / From/To / Reason for Leaving / Tick if training scheme
Full time / Part time
Full time / Part time
Full time / Part time
Full time / Part time
Full time / Part time
Full time / Part time
L E G A L A N D C H I L D P R O T E C T I O N I S S U E S
45 / Is the child/young person’s name on the Child Protection Register?
Yes / No
If yes, Please give the following details:
Category of abuse (ie neglect, physical injury, sexual abuse or emotional abuse)
Date of current registration / Day / Month / Year
Date of any previous registrations / Day / Month / Year
Day / Month / Year
Day / Month / Year
Looking After ChildrenEssential Information Record Part Two6/7
903This table should be used to explain why and under what legal arrangements a child is being looked after. Whenever there is a change of / 46 / Record of changes to child/young person’s legal status when looked after by the local authority:
If the child/young person was in care when the Children Act 1989 was implemented please enter at item 5 the date when s/he was admitted. This date is required by the Department of Health only if a statistical return has not been made for this child since the Act was implemented.
care plan or a change in legal status
the reason for being looked after should be reviewed, and updated if / Day/month/year Item 5
necessary.
The Looking After Children Management and Implementation / Item 6 Item 11 / Reason for
New Episode
Guide explains how the information from this table should be categorised / Legal status began/ended Item 7 Legal Status Item 8
if it is to be used to complete the SSDA903 statistical return for the / 1 / 5 / 0 / 1 / 9 / 5 / 1 / Single accommodation placement / 43
Department of Health. The first row of the table has been completed as / 2 / 0 / 0 / 3 / 9 / 5
an example.
It is possible to regard all episodes of a defined series of short pre-planned / Act / Court
Placements under Regulation 13, Arrangements for Placement off / S 20 CA 1989 / n/a
Children 1991, as a single legal
status for the purpose of completing this section. / Reason for being looked after / Parents health / Item 9 / 01
Reason for change in
Legal Status / Episode of accommodation under S20 ceased in accordance with plan / Item 12 / 27
Where is a copy of the
agreement order kept? / On SSD File/copies with carers and parents
Please tick box if additional information is included on a / Item 6 Item 11 / Reason for
New Episode
isupplementary sheet / Legal status began/ended Item 7 Legal Status Item 8
Act / Court
Reason for being looked after / Item 9
Reason for change in
Legal Status / Item 12
Where is a copy of the
agreement order kept?
Item 6 Item 11 / Reason for
New Episode
Legal status began/ended Item 7 Legal Status Item 8
Act / Court
Reason for being looked after / Item 9
Reason for change in
Legal Status / Item 12
Where is a copy of the
agreement order kept?
Legal status (continued)6/7
Item 6 Item 11 / Reason forNew Episode
Legal status began/ended Item 7 Legal Status Item 8
Act / Court
Reason for being looked after / Item 9
Reason for change in
Legal Status / Item 12
Where is a copy of the
agreement order kept?
Item 6 Item 11 / Reason for
New Episode
Legal status began/ended Item 7 Legal Status Item 8
Act / Court
Reason for being looked after / Item 9
Reason for change in
Legal Status / Item 12
Where is a copy of the
agreement order kept?
Item 6 Item 11 / Reason for
New Episode
Legal status began/ended Item 7 Legal Status Item 8
Act / Court
Reason for being looked after / Item 9
Reason for change in
Legal Status / Item 12
Where is a copy of the
agreement order kept?
Item 6 Item 11 / Reason for
New Episode
Legal status began/ended Item 7 Legal Status Item 8
Act / Court
Reason for being looked after / Item 9
Reason for change in
Legal Status / Item 12
Where is a copy of the
agreement order kept?
Looking After ChildrenEssential Information Record Part Two6/7
This table should be used to store information about the following orders: family assistance, child assessment, non-residential / 47 / Other relevant orders relating to the child/young person:supervision, educational supervision, parental responsibility1, contact1, / Began/Ended / Legal provision / Act / Court
prohibited steps1, residence1 and specific issues1, orders restricting
contact1,2 and adoption orders1.
1Make sure further details are
recorded on this table. / Where is a copy of the order kept? / Further Details
2Check that full information about orders restricting contact is also recorded on the Placement Agreement and passed to carers.
Began/Ended / Legal provision / Act / Court
Where is a copy of the order kept? / Further Details
Began/Ended / Legal provision / Act / Court
Where is a copy of the order kept? / Further Details
Began/Ended / Legal provision / Act / Court
Where is a copy of the order kept? / Further Details
Looking After ChildrenEssential Information Record Part Two8/9
P L A C E M E N T H I S T O R Y
The Looking After Children Management and ImplementationGuide explains how the information / 48 / Please record all placements since first looked after away from home:from this table should be categorised / Item 6 / Item 11
if it is to be used to complete the SSDA 903 statistical return for the / Placement began / Placement ended
Department of Health. / Item 7
1This should be the name of the / Reason for new episode
foster carer or the manager of the residential unit. / Name1
2Some local authorities may wish to undertake further analysis of the reasons for leaving a placement, and create their own codes.
When the materials were being developed, the following reasons for / Address
placement moves were identified as
providing useful information: placement no longer available(eg / Main Placement / Yes / No
time-limited placement; unit closed
down; carer retired); planned transition to a new placement (eg / Type of Placement / Item 10
move from residential unit to foster care); placement disruption at the / Reason for leaving / 2
child/young person’s request or at the
carer’s request; death of a carer; child/young person absconded; / Planned move? / Yes / No
child/young person ceased to be looked after.
Item 6 / Item 11
Placement began / Placement ended
Item 7
Please tick box if additional information / Reason for new episode
is included on a
supplementary sheet / Name1
Address
Main Placement / Yes / No
Type of Placement / Item 10
Reason for leaving / 2
Planned move? / Yes / No
Item 6 / Item 11
Placement began / Placement ended
Item 7
Reason for new episode
Name1
Address
Main Placement / Yes / No
Type of Placement / Item 10
Reason for leaving / 2
Planned Move? / Yes / No
Item 6 / Item 11
Placement began / Placement ended
Item 7
Reason for new episode
Name1
Address
Main Placement / Yes / No
Type of Placement / Item 10
Reason for leaving / 2
Planned Move? / Yes / No
Looking After ChildrenEssential Information Record Part Two8/9
P L A C E M E N T H I S T O R Y – continued
Item 6 / Item 11Placement began / Placement ended
Item 7
Reason for new episode
Name1
Address
Main Placement / Yes / No
Type of Placement / Item 10
Reason for leaving / 2
Planned move? / Yes / No
Item 6 / Item 11
Placement began / Placement ended
Item 7
Reason for new episode
Name1
Address
Main Placement / Yes / No
Type of Placement / Item 10
Reason for leaving / 2
Planned move? / Yes / No
Item 6 / Item 11
Placement began / Placement ended
Item 7
Reason for new episode
Name1
Address
Main Placement / Yes / No
Type of Placement / Item 10
Reason for leaving / 2
Planned move? / Yes / No
Item 6 / Item 11
Placement began / Placement ended
Item 7
Reason for new episode
Name1
Address
Main Placement / Yes / No
Type of Placement / Item 10
Reason for leaving / 2
Planned move? / Yes / No
Looking After ChildrenEssential Information Record Part Two8/9
P L A C E M E N T H I S T O R Y – continued
Item 6 / Item 11Placement began / Placement ended
Item 7
Reason for new episode
Name1
Address
Main Placement / Yes / No
Type of Placement / Item 10
Reason for leaving / 2
Planned move? / Yes / No
Item 6 / Item 11
Placement began / Placement ended
Item 7
Reason for new episode
Name1
Address
Main Placement / Yes / No
Type of Placement / Item 10
Reason for leaving / 2
Planned move? / Yes / No
Item 6 / Item 11
Placement began / Placement ended
Item 7
Reason for new episode
Name1
Address
Main Placement / Yes / No
Type of Placement / Item 10
Reason for leaving / 2
Planned move? / Yes / No
Item 6 / Item 11
Placement began / Placement ended
Item 7
Reason for new episode
Name1
Address
Main Placement / Yes / No
Type of Placement / Item 10
Reason for leaving / 2
Planned move? / Yes / No
Looking After ChildrenEssential Information Record Part Two10
49 / Does the child/young person have any recorded offences or cautions? / Yes / NoDate / Offence / Type of Order / Court/police station
Please tick box if additional information is included on
a supplementary sheet.
F A M I L Y D E T A I L S
50 and 52 If yes, please give details including the extent to which his/her ability to act as a parent is affected. / 50 / Does the mother have any chronic condition, illness or disability (including drug and alcohol dependency)?Also include here any information about the risk of the mother/father passing on any genetically inherited diseases to the child. You will need to think about the issues of confidentiality in relation to some conditions such as HIV/AIDS and must consult agency policy in recording.
If you are completing this form in Wales, this question should read: / 51 / Does the mother speak and understand English fluently?
‘Does the mother speak and understand Welsh/English fluently?’ / Yes / No
Yes, Welsh / Yes,English
No
Please indicate her first language. / If no, please indicate her first language
Will an interpreter be needed at meetings? If so, please tick box.
52 / Does the father have any chronic condition, illness or disability (including drug and alcohol dependency)?
If you are completing this form in Wales, this question should read: / 53 / Does the father speak and understand English fluently?
‘Does the father speak and understand Welsh/English fluently?’ / Yes / No
Yes, Welsh / Yes,English
No
Please indicate his first language. / If no, please indicate his first language
Will an interpreter be needed at meetings? If so, please tick box.
Looking After ChildrenEssential Information Record Part Two11