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  • Checklist For Home Visitation

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    Sherryl S. Dueño
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    This document contains a checklist for a home visitation conducted by an elementary school. The checklist includes questions about the student's daily routine after class, sleep schedule, parental involvement in homework, relationships with siblings, playtime, and the parent's employment status. Space is also provided for remarks from the parent and signatures from the parent and teacher.

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    CHECKLIST HOME VISITATION

    Original Title

    Checklist for Home Visitation

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    This document contains a checklist for a home visitation conducted by an elementary school. The checklist includes questions about the student's daily routine after class, sleep schedule, parental involvement in homework, relationships with siblings, playtime, and the parent's employment status. Space is also provided for remarks from the parent and signatures from the parent and teacher.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    229 views1 page

    Checklist For Home Visitation

    Uploaded by

    Sherryl S. Dueño
    This document contains a checklist for a home visitation conducted by an elementary school. The checklist includes questions about the student's daily routine after class, sleep schedule, parental involvement in homework, relationships with siblings, playtime, and the parent's employment status. Space is also provided for remarks from the parent and signatures from the parent and teacher.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    of 1

    Division of ___________

    District of __________________
    ____________ELEMENTARY SCHOOL

    CHECKLIST FOR HOME VISITATION


    Name of Pupil:________________________________________________
    Parent/Guardian: _____________________________________________
    Date: _______________________________________________________
    Check the _____ which corresponds to the parents/ guardians answer.
    1. What is the first thing that your child does after class?
    _____Assignment _____Play/watch TV
    ____Home chores
    Other, please specify _____________________________________
    2. What time does he/she sleep?
    _____ 9 and beyond
    _____ not later than 11
    3. Do you ask him/her about school or check his/her assignment?
    _____Yes
    _____No
    _____Sometimes
    4. Who helps him/her on his /her assignment?
    _____Father
    _____Mother
    _____Siblings
    Other, please specify _____________________________________
    5. On weekends, do you check his/her notes?
    _____Yes
    _____No
    _____Sometimes
    6. How is he/she as a son/daughter?
    ______Fair
    _____Good

    _____Very Good

    7. How is his/her relationship with his /her siblings?


    ______Fair
    _____Good
    _____Very Good
    8. Does he/she have a regular playtime?
    _____Yes
    _____No
    9. How do you see him / her as a pupil?
    ______Fair
    _____Good

    _____Very Good

    10.Do you have a regular job?


    _____Yes
    _____No
    If Yes, please specify ___________________________________________
    Remarks:
    ______________________________________________________________
    ______________________________________________________________
    ______________________________________________________________

    _______________________________
    Parents / Guardians
    Signature
    _____________________
    Teachers Signature

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