Two Year Old Scheme

HOME VISIT REPORT (Aug 2012)

Please use this form as a basis for a discussion between parents, setting practitioner and
Children’s Centre worker and to record initial agreed actions. Please email when completed to:
carol.houghton@eastriding.gov.uk
NB – the form can be completed and returned by either the setting key worker or children’s
centre worker, but please fill in both names.

Date of visit Child’s

Name
Parents/carers Child’s
DOB
Address Parent’s
tel.
no/mobile
Setting Children’s
Practitioner Centre
Practition
er
Name of Setting Children’s
Centre

1. Child and Home Learning Environment – Initial Observations

What sort of communication occurred between the parents/carers and child during
the home visit?

How did the parents engage with the workers?

How did the parents react to the treasure basket and play ideas?

How did the child engage with the workers?

How did the child react to the treasure basket?

Additional support or services which may be needed for the child:

2. Objectives for Parents/Carers

Additional or updated information (to that in CAF or other assessment) shared by

parents/carers on the home visit (eg recent changes in family, child development or
health concerns, other issues or worries) :

Ideas for supporting parents in developing the Home Learning Environment (e.g.
visits to setting by parents, play or parenting ideas) Please say whether you have
discussed these at this point :

What do/does the parent/s hope to gain from the scheme for themselves? (eg
parenting skills, training, employment assistance) :

How can the Children’s Centre support the family/parents? (e.g. attending specific
sessions/courses, family support) :

3. Agreed Plan for Child at setting

Number of hours/sessions per

week for first 7 weeks
Date of first introduction visit
to setting
Proposed start date (funding
will start from the Monday of
the week child starts)
IMPORTANT: Please give 5
Week Review date here
(normally held at setting)
Parent has copy of report Date
YES/NO
Name of worker completing Date
report
Please complete the action plan below, which can be reviewed at Termly and
Final Review sessions.
Long term goal for the
family

Support needed Date Achieved

Steps family will take and by when Possible challenges Possible solutions
/by whom
2YOP Home Visit SUPPLY COVER CLAIM FORM

Name of Child……………………………………………………………… DOB …………………

Name of Setting……………………………………….………………………………………………

To be completed by childcare setting managers/childminders only

I request refund of supply cover incurred for a member of

staff to undertake this home visit:

Name of staff member………………………………………………..

Cost per hour (max 2 hours) £…………………

Total amount claimed £………………………..

Manager’s signature…………………………………………Date:
………………

Name……………………………………..………………….Tel no:………………

Please return this section only if you have put in place supply cover for the
staff member’s time spent on the home visit.