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 Practitioner Children’s
Centre
Practitioner
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 YES/NO Date

Name of worker completing report Date

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.