Forms Referenced on SAPPPs

 

#

60 Day Performance Review

80 Day performance Review

2008 OHS Monitoring Protocol

A

Absence Call-in Log

Accident and Illness Log Sheet

Accident Report

Acknowledgement of Forms Required by Licensing-English

Acknowledgement of Forms Required by Licensing-Spanish

Acknowledgement of Forms Required by Licensing-Vietnamese

ADA Reasonable Accommodation Request Form

Administrative Contacts and Customer Referrals

Admissions Agreement-English

Admissions Agreement-Spanish

Admissions Agreement-Vietnamese

Annual Health and Safety Checklist

Annual Performance Review

Antepartum Physicians Report

Application Status-English

Application Status-Spanish

Application Status-Vietnamese

B

Board of Directors Meetings

Board Packet Cover Page

Box Lunch Requisition

Breast Milk Error Report Form

C

CA Licensing Form: Emergency Disaster Plan for Child Care Centers (LIC610)

CALIFORNIA School Immunization Record (Blue Card)

CALIFORNIA School Immunization Record

CAS Form

Case Management Meeting Form

Center Base Meal Record for Infants

Center Director Supervision Tracking Sheet

Center File Checklist

Center Visit Report

Center Visit Schedule

Center Visitor Accident Report

Center-Base Meal Record for Infants

Certification of Receipt of OCHS SAPPP #FI-02 "Use of Agency and Personal Credit Cards"

Checklist for Skills Progression

Checklist for Solid Food Introduction

Child Assessment Timeline 08-09

Child Assessment Timeline

Classroom Food Experience Request Form

Classroom Language Plan

Classroom Volunteers -Community

Classroom Volunteers -Parent

Code of Conduct for Consultants-Reviewers

Community Assessment Update

Community Resource Referral

Community Volunteer Services Contribution to OCHS

Confidentiality Agreement

Consent to be Audio/VideoTaped-English

Consent to be Audio/VideoTaped-Spanish

Corrective Action Plan Form

Corrective Action Steps

D

Daily Dishwasher Temperature Log

Daily Food Temperature Record Placentia

Daily Food Temperature Record Ted Fisher

Dental Examination Form

Disabilities Services Checklist

Disaster Drill Form

Dishware/Silverware Tracking Sheet

Division Training Priorities

Donated Goods

Donated Services

Donated Space-Facilities

DRDP-R assessment Tool 08-09

E

Education Classroom and File Checklist

Education Home Base Checklist

Education Manager Center Visit Report

Education Manager’s Tracking Sheet

EHS Child Nutrition History

EHS Daily Classroom Health and Safety Checklist

EHS Grocery List Order Form

EHS Infant Nutrition History

EHS Parent Request for Alternae Formula-English

EHS Parent Request for Alternae Formula-Spanish

EHS Pediatric Health History -English

EHS Pediatric Health History -Spanish

Eleven Month Centers Closures-page 1

Eleven Month Centers Closures-page 2

Emergency Incident Coordinators

Employee Claim for Worker Compensation Benefits Form

Employee Work Related Injury Report

End of the Year Checklist

Equipment Check-out Log

ERSEA-Agency Checklist

ERSEA-File Review Checklist

Evaluation of Socialization

F

Family Information- English

Family Information- Spanish

Family Partnership Agreement Eng-Span

Family Partnership Agreement Eng-Viet

Family Partnerships Checklist

Field Trip Permission 08-09

Field Trip Request

First Aid Supply Inventory Form

First Day of Attendance, Transfer and-or Termination Notification

Food Delivery Record-Early Head Start

Food Delivery Record-Part-Day-Full-Day

Food Response Form

Food Services Sanitation and Safety Monitoring

Food Substitution Physician’s Statement

Food, Safety & Sanitation Monitoring Response

Formula Substitution Physician’s Statement

G

General Referral Checklist

General Referral

Group Babysitting Reimbursement

Guidelines for Giving Medication

H

Health History-English

Health History-Spanish

Health History-Vietnamese

Health Services Checklist

Health Services Summary

Home Base Socialization Lesson Plan

Home Base Socialization Snack Request

Home Base Weekly Lesson Plan I & II

Home-Base Weekly Lesson Plan

Home Visits

HOTV Eye Screening Chart

I

Immunization Schedule

Implementation Plan/Information Meeting

Incident Report

Income Eligibility Worksheet

Individual Health Care Plan

Individual Improvement Plan

Individual Needs and Services Plan

Individualization Notes

Individualized Development Plan

Individualized Evacuation Plan

Infant and Toddler Food Warnings

Infant and Toddler Parent-Caregiver Information Exchange

Inside Daily Safety Checklist

Integrated Services Meeting-Obsevation

IIntegrated Services Team Meeting Form

Integrated Services Team Meeting-Administration Office.pdf

K

Kitchen Supplies Request Form

L

Lead Trainer Event Evaluation

Leave of Absence Request

Life Threatening Food Allergy Letter to Parents-English

Life Threatening Food Allergy Letter to Parents-Spanish

Life Threatening Food Allergy Letter to Parents-Vietnamese

Limited Term Leave Request

Limits of Confidentiality-English

Limits of Confidentiality-Spanish

M

Medication Error Report

Medication Procedure

Mental Health Services Checklist

Menu Production Record

Menu Suggestion Form-English/Spanish

Menu Suggestion Form-English/Vietnamese

Mileage Log

Monthly Classroom Milk Count Sheet

Monthly IMFT Report

Monthly Meal Count Form

N

Notification of Informal Agreements

Nutrition Services Checklist

O

Observation

OCHS Independent Contractor Status Questionnaire

Outside Daily Safety Checklist

P

Parent & Personal Rights-English

Parent & Personal Rights-Spanish

Parent and Staff Agreement Regarding Special Concerns

Parent Authorization for Exchange of Information

Parent Committee Meeting (PCM)

Parent Contact

Parent Directory-English/Spanish

Parent Directory-Vietnamese

Parent Guardian Permission Form for Use of Child's Photograph

Parent Interest Survey-English

Parent Interest Survey-Spanish

Parent Interest Survey-Vietnamese

Parent Permission Form for Counseling-English

Parent Permission Form for Counseling-Spanish

Parent Request for Alternate Formula-English

Parent Request for Alternate Formula-Spanish

Parent Request for Administration of Medication to Child

Parent's Right to Refusal of Services-English/Spanish

Parent's Right to Refusal of Services-English/Vietnamese

Parental Request for the Administration of Medication to Child

Participant Training Evaluation

Personnel Requisition Form

Physical Examination -Early Head Start

Physical Examination

Physician's Request for the Administration of Medicine

Policy Council Meeting Time Survey

Policy Council Meetings (PC)

Policy Council Presentation Request Form

Postnatal-Newborn Two Week Home Visit Interview

Postpartum Depression Self Assessment-English

Postpartum Depression Self Assessment-Spanish

PPA Form

Pre-Award Checklist

Pre-designated Physician's Form

Pregnant Women Infant and Toddler Care Program Checklist

Prenatal Nutrition Questionnaire-English

Prenatal Nutrition Questionnaire-Spanish

Program Services Enrollment File Checklist

Promising Practice Detail Report

Q

 

R

Receipt Voucher For In-Kind Contributions

Referral Follow-up Request Form-English/Spanish

Referral Follow-up Request Form-English/Vietnamese

Refrigerator/Freezer Temperature Log-Central Kitchen-Placentia

Refrigerator/Freezer Temperature Log-Central Kitchen-Ted Fisher

Refrigerator/Freezer Temperature Log-Satellite Kitchen

Required Oral Examination Form

Resource Room Requisition Check-Out Form

S

Safe Environments-Annual Checklist

Safe Environments-Monthly Checklist

Selection Letter-English

Selection Letter-Spanish

Selection Letter-Vietnamese

Self Declaration/Income Certification-English

Self Declaration/Income Certification-Spanish

Service Delivery Documentation Pg 1

Service Delivery Documentation Pg 2

Socialization Meal Report

Socializations (SOC-M)

Staff and Consultant Sign-In Log
STATUS OF ELIGIBILITY FOR SPECIAL NEEDS

Student Emergency Card En-Sp

Student Emergency card En-Viet

Student Emergency Information Card

Student Emergency Information Viet

Substitute Assignment Form-Teachers, Kitchen Staff

Substitute Assignment

Supervisor's Work-Related Injury Report

Supply Order Form

Suspected Child Abuse Fax Report

Suspected Child Abuse Report

Systems Checklist

T

Template D Memo

Temporary Meal Count _2 Per Page_

Temporary Meal Count _4 Per Page_

Training Outline

Training Participant Roster

Travel Advance Request

V

Vehicle Maintenance Log

Vision and Hearing Screening E-S-V

Volunteer Project Application

W

Waiver of Liability and Certification

Witness Work-Related Injury Report

Y

Yellow Staff Emergency Information

 

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