Educator Home Visit Record

• Conducted on

  Date

• Prepared by

• Location
  Address

• Educator

• TRIM file number

SITE INFORMATION

• Front door locked

• Time sheets sighted / receipts given

• Visitor's book signed

• Sleep log checked

• Sleeping children sighted

  N/A

  Yes

  No

• Location of sleeping children

• Accessible areas sighted

• Inaccessible areas locked/secure

• Environmental checks complete

• Weather:

  Select Hot Cold Wet/ raining Cloudy Warm/sunny Overcast

  • Hot
  • Cold
  • Wet/ raining
  • Cloudy
  • Warm/sunny
  • Overcast

• Pets inaccessible to children

  N/A

  Yes

  No

• Pet food / water / bedding inaccessible to children

  N/A

  Yes

  No

• Comments

ON ARRIVAL

• What are the children involved in?

• Add media

  Media

• Television

  On

  Off

• Music

  On

  Off

CHILDREN IN CARE

• Child 1.

• Child 2.

• Child 3.

• Child 4.

• Child 5.

• Absent:

• Other people present:

PROGRAM / PLANNING CYCLE

• Up to date:

• Displayed:

• Daily Diary up to date

  Select N/A Yes No

  • N/A
  • Yes
  • No

• Child observations

• Intentionally teaching/planned activities

• Reflection

• Add media

  Media

• Comments

NUTRITION

• Weekly menu displayed:

• Changes to the menu documented

• Was water accessible to children:

• Add media

  Media

• Comments:

GENERAL COMMENTS

• Add media

  Media

• Educator Goals:

• Follow-up required by Educator:

• CDC Follow - up:

• Educator's Signature

  Sign

• CDC's Signature

  Sign