Daily Care Connection Form
Daily Care Connection
Special Education Daily Home-School Log
Day: M T W Th F
Student:
Date:
Staff / Lead:
TODAY'S MOOD & ENERGY
Select all observed
Happy Calm
Excited Active
Tired Low energy
Anxious Unsettled
Upset Frustrated
MEALS & HYDRATION
Water: [ ] Lots [ ] Fair [ ] Low
Breakfast:
All Most Some None
Lunch:
All Most Some None
Snack:
All Most Some None
SPECIALS & RELATED SERVICES ATTENDED
Check all that apply today
Art
Music
P.E. / Gym
Library
Recess / Outdoor
Sensory Room
Speech / Language
OT / PT
BEHAVIOR & CLASSROOM PARTICIPATION
Scale: Independent / Prompted / High Support
Calm Body
Most of the day
Needed 1-2 reminders
High support needed
Safe Choices
Safe hands & feet
Redirected quickly
Difficult moment
Following Directions
Ready on 1st prompt
Visual/verbal prompts
Resisted transitions
Helpful Supports Used Today:
Visual schedule Sensory / movement break Timer / countdown Quiet corner reset Fidget / weighted tool 1:1 verbal co-regulation
DAILY CARE & HEALTH NEEDS
Personal care logs
Bathroom & Diapering: [ ] Dry all day [ ] Accident
Independent trip Staff assisted change Prompted scheduled trip Diaper / Pull-up checked
Times / Notes:
Health & Rest: Meds: [ ] Yes [ ] N/A
Energy level: [ ] Alert [ ] Sleepy [ ] Rested
Health note:
*Nurse visit log attached if medication administered.
TODAY'S BRIGHT SPOT & CELEBRATION A victory to celebrate at home!
Teacher / Staff Notes: [ ] Supplies needed
Family Notes / Comments:
Parent Initials: