ESCLEW 2017-2018 Site Visit Report with General Student Files

• School Name

• Site Visit Date

  Date

• Prepared By

• Start Time

  Date

• End Time

  Date

• School Personnel Involved

Site Visit Review Items for the Month

• Site Visit Review Items

Comments and Documentation

• Other Items Discussed

• Stakeholder Data to be Collected

  Select Students Parents Staff Governing Authority Members Other

  • Students
  • Parents
  • Staff
  • Governing Authority Members
  • Other

• Stakeholder Interview(s)

• Technical Assistance and Guidance Provided

• Areas of strength for this month

Areas for Improvement Identified this Month

• Area for Improvment

• Action Steps Required

• Timeframe for Completion

Follow-Up on Previously Identified Areas for Improvement

• Area for Improvement

• Progress of Action Steps Required

• Timeframe for Completion

• Improvement Progress

  Met

  Progressing

  Unmet

Summary of Findings

Student Files

Student File Checklist

• Sign- In Sheet Included?

  Yes

  No

  N/A

Biographical Information

• Student Initials

• Student ID Number

• Grade Level

• Birth Certificate with Proper Name/Spelling

  Yes

  No

  N/A

• Explanation

• Proof of Residency

  Yes

  No

  N/A

• Explanation

Health Information

• Signed Emergency Medical Release

  Yes

  No

  N/A

• Explanation

• Immunization Chart

  Yes

  No

  N/A

• Immunizations Current

  Yes

  No

  N/A

• Explanation

• Vision Screening

  Yes

  No

  N/A

• Vision Current? (K,1, 3, 5, 7, 9, New Student)

  Yes

  No

  N/A

• Explanation

• Hearing Screening

  Yes

  No

  N/A

• Hearing Current? (K, 1, 3, 5, 9, 11, New Student)

  Yes

  No

  N/A

• Explanation

Academic Information

• Most recent school grade report

  Yes

  No

  N/A

• Explanation

• State Test Results

  Yes

  No

  N/A

• Explanation

• Did the student transfer from a different school?

  Yes

  No

  N/A

• Records Release?

  Yes

  No

  N/A

• Explanation

• Transcript from previous school

  Yes

  No

  N/A

• Number of Requests Documented

• Date of most recent request

  Date

Overall Assessment

• General Comments or Concerns

• Student File - up Needed?

  Yes

  No

  N/A

• Follow up will take place