Section 1: Pupil and School Details

To be returned to the EHC Assessment Team within 10 working days of the meeting taking place.

Section 1: Pupil and School Details

Insert date of this review:
(DD/MM/YYYY)
Surname: / Forenames:
Date of Birth: / Gender:
National Curriculum Year: / Name of School Attended:
Home Address: / School Address:
Post Code: / Post Code:
Home Telephone No: / School
Telephone No:
Is the pupil ‘a Child in Care’ to the Local Authority? / Yes / No
Is the pupil considered to have a ‘disability’ under the Equality Act 2010? / Yes / No
Name of person(s) with parental responsibility: / Name of person(s) with parental responsibility:
Relationship: / Relationship:
Address: / Address:
Post Code: / Post Code:
Contact No: / Contact No:
e-mail: / e-mail:
Can documents be sent via e-mail? / Can documents be sent via e-mail?

Section 2: Review Participants

Record the level of involvement of all those invited to the Review Meeting

Name / Designation/Role / Invited
 / Attended
 / Written evidence submitted


Section 3: Summary of feedback from the pupil, parents and other professionals

What do we like and admire about the pupil?
What is important to the pupil now? / What is important to the pupil for the future?
What is working well? / What isn’t working well?
Review of outcomes on the EHC Plan/ Statement:
Outcomes: / Has outcome been met? / Progress being made to achieve
outcomes:
Met / Partially Met / Not met
Cognition + Learning:
Social, Emotional and Mental Health:
Speech/Language and Communication:
Sensory/ Physical:
Independence and Self Help:
New outcomes to be actioned:
Area of Need / Outcomes:
Cognition & Learning
Social, Emotional Wellbeing & Mental Health
Speech/ Language & Communication
Sensory/ Physical
Independence and Self Help
Additional comments:

Section 4: Action Plan

Identify details of any further action required, and specify by whom:
Issues identified / Nature of action required / Name of person responsible / Specify timescale

Section 5: Recommendations of the Review

Recommendation / Action (indicate “Yes” or “No”)
Maintain EHC Plan
Amend the EHC Plan
Cease the EHC Plan
Re-assess the child’s needs
Maintain the Statement
Amend the Statement
Cease the Statement
Convert to EHC Plan

Section 6: Forward Planning

Proposed date of next Annual Review Meeting (MM/YY):

Section 7: Declaration

This Report is an accurate record of the Annual Review Meeting

Completed by (Print): ...... Designation: ......

Signed: ...... Headteacher …………………………..

Date: ......

(DD/MM/YYYY)

______

This form must be sent to the EHCP Co-ordinator for your school and all those who attended within 10 working days from the meeting date.

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