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SAMPLE FORMS FOR EARLY CARE
AND EDUCATION PROGRAMS


The documents listed on this page are examples only! Content of each document is based on national recommendations and requirements, as well as sample forms from other ECE programs.

You are welcome to download these documents as examples for your own program. The individual documents may not include all the information needed for your specific program. Please carefully review all related Federal, state, and local requirements, as well as written policies for your program; then, you may modify these documents to meet the needs of your program.

Posters:

You are welcome to download these posters for use in your program.  If you need modifications or posters on other topics, please contact Dr. Hendricks.  Posters are available in English or Spanish.

Choking Hazards Poster English Spanish Bilingual
Washing Hands Poster English Spanish Bilingual
Family Style Eating Poster English Spanish  
Well-Child Visits English Spanish Bilingual
Sun Safety English Spanish  
Keep Rules Simple English Spanish  
Tooth Brushing English Spanish Bilingual
Buckle Up! English Spanish Bilingual
Standard Precautions English Spanish  

Emergency Posters:

(Tornado or Severe Weather; Utility Disruption; Potentially Violent Situation; Chemical, Biological, or Hazardous Material; Earthquake; Flooding; Fire)

Disaster Posters
(English)
Disaster Posters (Spanish)


Sample Classroom Emergency Poster  (English)  Revised
Sample Classroom Emergency Poster  (Spanish)

Emergency Preparedness Forms:

Disaster Preparedness Supply Checklist  (English)
Disaster Preparedness Supply Checklist  (Spanish)

Most authorities recommend preparing for three or more days (72 hours). Begin with a basic list of supplies; then work with a team to review and complete the list so that all children’s needs are met. 

Basic First Aid Kit Checklist ( English)  Revised
Basic First Aid Kit Checklist (Spanish)

Health Related Forms:

Injury Reporting 

Administration of Medication
Document parent authorization and administration of medication. 

Daily Health Check (English)  Revised

Staff should complete a visual check of each child upon arrival and before the parent leaves.  A child who appears to be ill may be sent home or to the doctor/clinic as appropriate.

Training Evaluation Forms:

A generic form to be used to evaluate your training sessions, regardless of topic.  Specific pre/post evaluation forms are also available for each of the available modules.  (Click here to see training topics.)  Please refer to the specific training page to download these documents. 

Click here to download this generic form in English, or Spanish.

Community Assessment Forms:

This questionnaire may be modified and used to collect data from the target population; resulting information may supplement other community assessment data. 

Community Assessment Questionnaire (English)  Revised
Community Assessment Questionnaire (Spanish) New

Sample forms on additional topics may be available.
Click
here for more information.

 

 

 

Click here for more information on the
25 different Training
Programs Available!

Dr. Hendricks,
 
 I'm very happy with the HIP on Health mini-posters.  Our Head Start and Early Head Start Staff alike will be using them.  The Family Educators take out lots of information to the families and must be very careful when using the internet to find good information to give.  This will be so much easier for them and there's such a nice variety of topics!
 
 Thanks,
 Mary Allison
   

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