Looking After Children

/ Essential Information Record: Part One1
SSID CASE ID
/ C256362
SSID PARTY ID

Children’s Services

Looking After Children

ESSENTIAL INFORMATION RECORD: PART 1

Personal information for a child or young person looked after by a local authority

Forenames
Family name
Please underline names normally used. If it has been agreed that the child/young person should be known by another name (e.g. foster carer’s or step-parent’s family name), please specify:
Gender / MaleFemale
Date of birth / Day / Month / Year
Date this form first completed
Part One / Day / Month / Year
Part Two / Day / Month / Year
Dates of updating
Social Worker’s name
Responsible authority
Team
Address
Postcode
Telephone
Please tick box if additional information/new addresses are included on a supplementary sheet
PERSONAL DETAILS
1.Child/young person’s home address
Postcode
Telephone
Name of principal carer at this address
Relationship to child/young person
2.Ethnic/racial origin of birth mother
3.Ethnic/racial origin of birth father
4.With what culture does the child/young person most identify?
5.Does the child/young person have a religion? / Yes No
If ‘Yes’, please give details and indicate whether: / Nominal Practising
6.Languages spoken at home
First Language / Other Languages
7.Does the child/young person speak English?
Frequently With difficulty Not at all Too young
Comments:
8.Does the child/young person understand English?
Always Usually Sometimes Not at all Too young
Comments:
9.If the child/young person uses a form of communication other than speech (e.g. Makaton, British Sign Language, Bliss), please specify:
HEALTH
/ 10.Ongoing health conditions/disabilities / Asthma / Cerebral palsy
Coeliac disease / Cystic fibrosis
Diabetes / Eczema
Epilepsy / Glue ear
Hayfever / HIV infection
AIDS / Sickle cell anaemia
Thalassemia / Visual impairment
Learning disability / Physical disability or mobility problems
Hearing impairment
Any other conditions likely to require out-patient appointments or hospital admissions?
Yes No
Please specify:
11.Details of condition(s) noted at Question 10 above and current treatment:
Please specify:
12.Does the child/young person have specific dietary needs or restrictions for cultural or health reasons?
Yes No
Please specify:
13.Is the child/young person known to suffer from any allergies?
Yes No
Please specify:
14.Aids and appliances used by the child/young person, including spectacles, dental fittings and specialist educational equipment (e.g. materials in Braille):
FAMILY DETAILS
15.Mother’s name / Forename / Family name
Date of birth / Day / Month / 1 / Year
(If exact date unknown, please give year)
Address if different from child/young person
Postcode
Telephone
Day time telephone if different from above
16.Father’s name / Forename / Family name
Date of birth / Day / Month / Year
(If exact date unknown, please give year)
Address if different from child/young person
Postcode
Telephone
Day time telephone if different from above
17.Does the birth father have ‘parental responsibility’ (cf the Children Act 1989 Section 2)?
Yes/married to motherYes/order
Yes/agreementNo
18.Other significant adults
a)Name / Relationship
Address / Responsibility
YesNo
Postcode

Continued on page 5.

b)Name / Relationship
Address / Responsibility
YesNo
Postcode
c)Name / Relationship
Address / Responsibility
YesNo
Postcode
d)Name / Relationship
Address / Responsibility
YesNo
Postcode
19.Brothers and sisters
a)Forename
Family name
Ethnic/racial origin if different from this child
Date of birth / Day / Month / Year
Please tick box if looked after away from home
Current address
Postcode
/ Name of carer
Relationship to carer
Relationship to child/young person1

Continued on page 6.

b)Forename
Family name
Ethnic/racial origin if different from this child
Date of birth / Month / Year
Please tick box if looked after away from home
Current address
Postcode
/ Name of carer
Relationship to carer
Relationship to child/young person1
c)Forename
Family name
Ethnic/racial origin if different from this child
Date of birth / Day / Month / Year
Please tick box if looked after away from home
Current address
Postcode
/ Name of carer
Relationship to carer
Relationship to child/young person1
d)Forename
Family name
Ethnic/racial origin if different from this child
Date of birth / Day / Month / Year
Please tick box if looked after away from home
Current address
Postcode
/ Name of carer
Relationship to carer
Relationship to child/young person1
e)Forename
Family name
Ethnic/racial origin if different from this child
Date of birth / Day / Month / Year
Please tick box if looked after away from home
Current address
Postcode
/ Name of carer
Relationship to carer
Relationship to child/young person1
PROFESSIONAL CONTACTS
20.School
School name
Head teacher
Class teacher
Address
Postcode
Telephone
21.General Practitioner
GP name
GP address
Postcode
Telephone
/ 22.Health Visitor
GP name
GP address
Postcode
Telephone

ALL THE LOOKING AFTER CHILDREN FORMS MEET THE REQUIREMENTS OF THE CHILDREN ACT 1989.