Education, Health and Care Needs Assessment Information Form(Primary Education)
Guidance
This information is sought in accordance with the Children and Families Act 2014. In the first instance all educational settings are required to use their best endeavours to meet the needs of children and young people identified with Special Educational Needs. In providing information, the educational setting must evidence the following:
  • a copy of the child's additional support planwhich demonstrates the assess, plan do, review cycleprovided for them under SENSupport as indicated in the Code of Practice 2015;
  • educational assessments of the child’s difficulties completed by the school as part of the cycle;
  • the outcomes sought by the school for the child;
  • the external professional advice that has been sought and information about how it has been implemented;
  • details of the support and interventions that have been provided for the child;
  • an assessment by the school of the interventions used and subsequent progress or lack made by the child;
  • anyadditional support school staff feel is required which cannot be provided through the school’s ordinary resources.

Contact details
Child’s first name: / Child’s surname:
Gender: / Male  Female  / Is the child in care/ looked after? / Yes  No  Don’t know 
Date of birth: / Year Group: / Key stage:
Name of setting: / Type of setting: / Maintained 
Non maintained 
Mother/ carer’s name: / Telephone number:
Address:
Postcode: / email:
Father/ carer’s name: / Telephone number:
Address (if different from above):
Postcode: / email:
Areas of need: / Communication & Interaction  / Cognition & Learning  / Social, emotional & mental health  / Sensory &/or physical 
Current Attendance Record - please provide as much information as possible
Name of Educational Setting / Period (Dates) / Actual Attendance
(No. of Sessions) / Possible Attendance
(No. of Sessions) / Percentage Attended
SECTION A
The identified Special Educational Needs – What difficulties are acting as barriers to curriculum access and progress? You may wish to complete more than one section.
Speech, language, communication and interaction
Cognition and Learning
Social, Emotional and Mental Health
Sensory and/or Physical Needs
Are there any relevant/significant health and/or social care factors? Yes /No (delete as appropriate) If the answer is yes please attach copies of relevant information.

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Issued: September 2016 Review date: August 2017 Feedback to:

SECTION B
Attainment/Ability Assessments/Milestones Met:
Please add the last Key Stage data and as many other data points as available.
Date / Year Group / Key stage / TA or SATs / Spelling age / Speaking and listening / Writing / Reading / Maths / Science
Baseline on Entry / Please attach this information separately
Reception / Please attach this information separately
1 / 1
2 / 1
3 / 2
3 / 2
4 / 2
5 / 2
6 / 2

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Issued: September 2016 Review date: August 2017 Feedback to:

SECTION C:
Current support arrangements: give details of the targeted support provided for the child that is additional to and different from normal differentiated group arrangements.
Name of intervention / Intended outcomes from intervention / Frequency, Duration, style of delivery (group/individual) / Delivered by (indicate role) / Start
Date / Review
Date / Outcomes: (Achieved, Partially Met, Not Met)
Additional support: What additional support do you feel is required over and above that already provided?
Name of intervention / Intended outcomes from intervention / Frequency, Duration, style of delivery (group/individual) / Delivered by (indicate role)
Professional Involvement - Please indicate if there is or has been involvement from any educational support services (eg. Educational Psychologist, Specialist Teacher), health and/or social care (if reports are available please attach and indicate in the table)
Service provided by: (Name & Role) / Date(s) of report(s) / Date(s) assessed / Brief description of evidence attached

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Issued: September 2016 Review date: August 2017 Feedback to:

SECTION D:
Funding – All mainstream schools are provided with resources to support those with additional needs,including students with SEN and disabilities.Please identify the provision made from the schools budget to address the child/young person’s needs.
Term (add dates) / Funding amount
SECTION E:
Please sign this form indicating your role in the organisation.
Name: / Signature:
Date: / Title:
Contact email address: / Contact number:
In line with the SEN Code of Practice (2015) education settings are advised to discuss the request for an EHC needs assessment fully with parents/carers and young people and to only submit a request with their agreement. Please return this form, together with any reports or other supporting information, to your local Statutory Assessment Service office.
Mid – covering Braintree, Chelmsford, Halstead and Maldon / South – covering Basildon, Billericay, Brentwood, Castle Point, Rochford and Wickford

Statutory Assessment Service
2nd Floor, Causeway House
Bocking End
Braintree CM7 9HB /
Statutory Assessment Service
Ground floor, Ely House
Ely Way
Basildon SS14 2BQ
North East – covering Colchester and Tendring / West – covering Epping, Harlow and Uttlesford

Statutory Assessment Service
Ground floor, Essex House
200, The Crescent
Colchester CO4 9YQ /
Statutory Assessment Service
Ground floor, Goodman House
Station Approach
Harlow CM20 2ET

For office use

Date Received: / Response due by:
Officer: / Initiation Panel Date:

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Issued: September 2016 Review date: August 2017 Feedback to: