Early Years Improvement Team
Prospective Childminding
Self Assessment Form
(Please print clearly)
Date of Assessment:
First name: Surname:
Address:
Tel: Mobile:
(Please print clearly and ensure your full email address is included)
Email:
Experience of children and relevant training:
Question 1
What experience or knowledge do you have with children and why do you want to become a childminder?
Question 2
Do you have any qualifications in Childcare? YES q NO q
If yes, please write in the box below, what qualification this is including the level.
If you have any other qualifications equivalent to Level 3 or above, please also include details of this below.
Question 3
Do you have a valid Paediatric First Aid certificate? YES q NO q
(It is a requirement to provide evidence of this which will
include attending a minimum of 12 hours of training)
Question 4
Do you need support with English? YES q NO q
Question 5
Are you confident and competent in reading written YES q NO q
English, and also writing records of information?
(If not you should seek support by attending a course in English or English for Speakers of Other Language - ESOL)
Question 6
Are you in good health? YES q NO q
(Evidence of this will be required)
(If you are concerned about any aspect of your health, which might
affect your ability to childmind, please discuss this with your doctor)
Question 7
Are you in receipt of any benefit? YES q NO q
(It is advisable to speak to your benefit advisor, to find out how
childminding will affect your benefits)
Question 8
Does anyone in your household have a criminal record? YES q NO q
(All convictions need to be declared including any cautions. Not
all offences will prevent you from being registered)
Information about your home:
Question 9
What type of property do you live in? (please tick)
q House q Flat (high rise)
q Flat/Maisonette (low rise) q Studio Flat (one room premises)
q Hostel q Pub or other commercial property
Question 10
Are you in the process of doing any of the following? (please tick all that apply)
q Decorating q General repairs q Building work
(It will be necessary to carry out a risk assessment on your home to identify any potential hazards)
Question 11
Do you have direct access to a garden? YES q NO q
If YES:
Will you be using your garden? YES q NO q
If NO:
How will you provide children with regular access to outdoor play?
Question 12
Do you share your garden with other residents or neighbours? YES q NO q
If YES:
Please give details of how or if the garden can be used.
Question 13
Do you have a pond? YES q NO q
(If YES, you will need a weight bearing cover for any ponds, drains or water butts)
Question 14
Do you or any members of your household smoke? YES q NO q
(In accordance with smoking laws there must. be NO SMOKING during
the childminding working hours in any part of the home and garden)
Question 15
Do you have any pets or animals? YES q NO q
If YES:
What pets or/and animals do you have?
Are the pets or/and animals in good health and are they safe YES q NO q
to be around children?
Question 16
Is there anything else you would like to tell us about yourself?
Thank you for completing this form. Please return by email if possible to: or by post to: The Early Years Improvement Team, 3rd Floor, Laurence House, Catford, SE6 4RU.
Once we have received your completed ‘Self Assessment’ form , the next stage of the process, is to attend a Local Authority ‘Pre-Registration briefing’ session.
Please inform me of the date of the next available briefing session q
It is also a requirement for all Childminders to have a good understanding of the Early Years Foundation Stage and to complete relevant training. For more details on the process and the training required, including the cost please see the information enclosed.
Name (Please print clearly): …………………………………………………………………….
Email: ………………………………………………………………………………………………..
Signature: ……………………………………………… Date: …………………………………
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