Site Visit

Start Time

School Personnel Involved

Required Monthly Rubric Items

Other Items Discussed

Technical Assistance or Guidance Provided by Sponsor

Areas of Strength

Compliance Concerns or Suggestions

Overall Assessment

Items Requiring Follow-up

End Time

Student File Checklist

Student Files

Student File Checklist

Student File

Sign-In Sheet Included?

Biographical Information

Student Initials

Student ID Number

Grade Level

Birth Certificate with Proper Name/Spelling

Explanation

Proof of Residency

Explanation

Health Information

Signed Emergency Medical Release

Explanation

Immunization Chart

Immunizations Current?

Explanation

Explanation

Vision Screening

Vision Current? (K, 1, 3, 5, 7, 9, new students)

Explanation

Explanation

Hearing Screening

Hearing Current? (K, 1, 3, 5, 9, new students)

Explanation

Explanation

Academic Information

Did student transfer from a different school?

Records Release

Explanation

Transcript from Previous School

Number of Release Requests Documented

Date of Most Recent Request

Most Recent School Grade Report

Explanation

State Test Results

Explanation

Overall Assessment

General Comments or Concerns

Student File Follow-up Needed?

Special Ed File Checklist

Special Education Files

Special Education File Checklist

Special Education File

Sign-in Sheet Included?

Biographical Information

Student Initials

Student ID Number

Grade Level

ETR

Date Current (ETR must be done every three years)

Is the current ETR the student's original ETR?

Referral (PR-04) in original ETR

Referral (PR-04)

Prior Written Notice (PR-01)

Parent Invitation (PR-02)

Parent Consent (PR-05)

ETR Body (PR-06)

Appropriate Signatures
(district rep, regular ed teacher, special ed staff, parent, student (if present))

Missing Signatures/Explanation

ETR Comments/Concerns

IEP

Date Current (IEP must be done every year)

Parent Invitation (PR-02)

Future Planning, Special Instructional Factors, Profile (Sections 1-3)

Post-Secondary Transition (Sections 4/5)

Was the student invited to the IEP meeting? (required for 14+)

Explanation

Goals and Specially Designed Services (Sections 6/7)

Services Aligned with Goals

Explanation

Least Restrictive Environment (Section 11)

Statewide and District-Wide Testing Accommodations (Section 12)

Is the student approved for alternate assessment?

Appropriate Signatures
(district rep, regular ed teacher, special ed staff, parent, student (if present))

Missing Signatures/Explanation

Documentation that School is Providing Related Services

IEP Progress Reports

Explanation

IEP Comments/Concerns

Overall Assessment

General Comments or Concerns

Special Ed File Follow-up Needed?

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.