PUPILS EDUCATED AT HOME

CONFIDENTIAL

Exit from School Roll - Review Form

The purpose of this form is to determine whether or not there are any Safeguarding / risk factors present which the LEA or other agencies should be aware of as the child in question will no longer be within a school community.

Name of Child: ____________________DOB: _______________________

Address: _______________________________

School: ______________________

_______________________________________

_______________________________________

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Does the child (in your view):

Have a special educational need: YES NO

Attend school regularly, i.e. above 90% (over the last 12 months)? YES NO

Relate well to pupils? YES NO

Relate well to adults? YES NO

Look fit and healthy? YES NO

Present as clean and hygienic? YES NO

Have positive parenting experiences? YES NO

Has the school:

Had regular face to face contact with parent or carer? YES NO

Had any issues raised regarding bullying of the child? YES NO

Had any issues risen regarding child anxiety? YES NO

Had any welfare concerns regarding the child? YES NO

Had any child protection concerns risen? YES NO

In your view, are there any potential risks of which other agencies should be aware YES NO

Are there any other children living in the same household? YES NO

Any other comments

________________________________________________________________

________________________________________________________________

Signature: _______________________________

Designation: _____________________________

Name: ______________________________________

Date:

Safeguarding - EHE exit from School Audit

Feb 2009