; Wigan Sure Start Early Years Inclusion Team
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Wigan Sure Start Early Years Inclusion Team

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  • pg 1
									                                                            INITIAL ASSESSMENT VISIT
1. Details
Name of Child:                                                  Date of Birth:                                              Today’s Date

Service / Setting Name:                                         Setting Number:                                             Service / Setting Representative:

2. Background              In this section record discussion of form SS2 and any additional information




3. Development             Use the spaces below to record specific information regarding the child
                                      Achieved         Developing     Emerging                                              Evidence

Physical Development


Communication / Linguistic
Development

Cognitive Development


Personal Development


Social Development


Emotional Development


Behaviour




Quality & Inclusion Team                         Working in Partnership with Wigan Council Educational Psychology Service                              SS6 1 of 2
Long Term Goals
Use this section to identify the next steps, which may include: drawing up or developing an action plan, collecting further information, carrying out observations
  Date                                 Aims                                         Action Required                          Person responsible         Review Date




Agreed Review date:




Signed: Service / Setting Representative                                             Signed: Early Years Quality and Inclusion Team

Date                                                                                 Date




Quality & Inclusion Team                       Working in Partnership with Wigan Council Educational Psychology Service                           SS6 2 of 2

								
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