Run Early Childhood Developmental Screening Tracking Log (ASQ) — Free

Child Enrollment and First Attendance

Child record identifies first attendance date critical (required)

Verify the child file includes the date the child first attended the program.

Yes No N/A

Enrollment date and attendance start are documented

Confirm the record shows the enrollment date and the first day of attendance, if different.

Yes No N/A

Child is within screening tracking population critical (required)

Confirm the child is included in the program's developmental screening tracking log or equivalent roster.

Yes No N/A

Responsible staff member is identified

Verify the record identifies who is responsible for screening completion and follow-up.

Yes No N/A

45-Day Screening Timeliness

Screening completed within 45 calendar days of first attendance critical (required)

Verify the developmental and social-emotional screening was completed no later than 45 calendar days after the child's first attendance date per 45 CFR 1302.33(b)(1).

Yes No N/A

Days from first attendance to screening completion critical (required)

Enter the number of calendar days between first attendance and screening completion.

Screening due date calculated correctly

Confirm the 45-calendar-day due date is calculated from the first attendance date and documented correctly.

Yes No N/A

Late screening has documented follow-up

If screening occurred after day 45, verify there is a documented explanation and follow-up action plan.

Yes No N/A

Screening Tool and Results

Appropriate screening tool is documented critical (required)

Verify the record identifies the developmental screening tool used, such as ASQ-3, and the social-emotional screening tool used, such as ASQ:SE-2, as applicable.

Screening results are recorded critical (required)

Confirm the child's screening results are documented in the log or file.

Yes No N/A

Results indicate pass, concern, or referral status

Verify the outcome is clearly identified, including any concern or referral status requiring follow-up.

Screening documentation is complete and legible

Confirm the screening record includes date, tool, result, and any required notes in a readable format.

Yes No N/A

Follow-Up and Family Communication

Family was notified of screening results critical (required)

Verify the family was informed of the screening outcome and any recommended next steps.

Yes No N/A

Referral or rescreening follow-up is documented

If results indicated concern, verify referral, rescreening, or other follow-up actions are documented.

Yes No N/A

Follow-up completion date is recorded

Enter the date follow-up action was completed, if applicable.

Documentation of consent or family communication is present

Confirm the file includes any required consent, communication log, or family contact documentation related to screening.

Yes No N/A

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Run: Early Childhood Developmental Screening Tracking Log (ASQ)

Child Enrollment and First Attendance

45-Day Screening Timeliness

Screening Tool and Results

Follow-Up and Family Communication

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