South Carolina Association of Community Action Partnerships (SCACAP)

Early Head Start — Child Care Partnerships (EHSCCP)

Infant/Toddler Daily Report

Today Date:
Child's Last Name: *
Child's First Name: *
Child's Middle Name:
Parent's Last Name: *
Parent's First Name: *
Parent's Middle Name:
Primary Teacher:
Class:
Center: *
Parent/Guardian Notes:


Drop-Off Time:
Who is Dropping Off Child?
Time My Child Woke Up:
Last Meal Time:
How He/She Slept:
General Mood:
Special Instructions:
Who Will Pick Up Child?
Approximate Pick Up Time:
Teacher Notes:

I Ate
Breakfast Time:
Lunch Time:
Snack Time:

Time W D BM LBM

Physical Condition Info from parent
Skin:
pale, flushed, rash, bruises, sores
Nose:
discharge (yellow, green), crusty
Breathing:
normal or different, wheezing, breathing fast or difficult, cough
Eyes:
pink/red, watery, discharge (yellow, green), crusty, swollen
Mouth:
sores, drooling, difficulty swallowing

Please submit immediately after each Parent/Teacher Contact.
Form must be completed in entirety.

I confirm that I have read and understand this form. *

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Parent Signature
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