SEN SPECIALIST SUPPORT
Record of Support and Intervention (ROSI) Form
Academic Year ______to ______
Name of MainstreamSchool/ Setting
Address of School/Setting
Staff contact
name / Tel Number
DfE Number
E-mail address
Name of Child or
Young Person
UPN / Date of Birth
Year Group and
Key Stage
Name of Outreach
Service
Teacher in Charge
Name of Outreach
Staff involved / Tel number
Email address

Information Box: Please note all boxes must be completed and for recording purposes referral form must precede ROSI

Please select the focus of your involvement (Insert an X into the relevant box)
Assessment (including observation, baseline
measures, standardised checklists) / Multi Agency Meeting (CAF / Annual Review
Transition meetings)
Intervention (including modelling / coaching
/ teaching / observation of good practice) / Training and professional development
Learning and Achieving (Universal provision,
early intervention, personalised provision) / Liaison (with Teacher / TA / SENCo/
dialogue with parents and/or carers,
other professionals)
Advice on strategies, resources, behaviour
management and care plans / Other (please specify)
CYPP Focus / Succeed in good school and other settings
EA1 / EA2
Be kept safe and protected from harm
SS1 / SS2 / Lead healthy lifestyles and have good
health care
BH1 / BH2
Positive choices for personal responsibility
PC1 / PC2 / Be economically secure
ES1 / ES2

SEN Specialist Support ROSI Revised (Std) v3 Sept 2013 1

(a) I n i t i a l A s s e s s m e n t I n f o r m a t i o n
Primary Need
Secondary Additional need(s)
Presenting Concerns and
Difficulties
Strengths / Interests
Current strategies in use
History of Interventions tried
Any identified risk / safe guarding / vulnerability issues
Baseline and/or standardised
assessment measures used / Measures of Educational Progress/Achievement
Measures of Emotional / Social / Communication / Behaviour
Please highlight (tick and date) the
range of assessment information
sources used / Interview (s) with parent (s) or family
members
Date: / Direct Observation
(please specify)
Date:
Records Documentation Review
Date: / Interview(s) with child or
young person
Date
Interview with setting/school staff/
Professionals
Date / Telephone
Date
Other (please state)
Pupil views, pre intervention
(as appropriate)
F o r m u l a t i o n
Assessment summary and
understanding
Next steps identified
Clarify role/actions
Overview of focus of time limited
Intervention
Date Record Completed: / Signed ……………………………………………

SEN Specialist Support ROSI Revised (Std) v3 Sept 2013 1

(b) I n t e r v e n t i o n O v e r v i e w / P l a n
Primary Intervention target (s) and objective (s) (bullet) / Responsibility of Key staff / Timescales
Universal and enhanced recommendations and strategies (bullet)
Specialist / Specific recommendations and strategies (bullet)
Agreed by:
(SENCO)
(Parents)
(SEN Specialist Support Key worker)
Relevant Evidence Base theory / references to support planned intervention offered (theory informing practice)
Date of proposed review/evaluation of intervention

SEN Specialist Support ROSI Revised (Std) v3 Sept 2013 1

I n t e r v e n t i o n V i s i t R u n n i n g R e c o r d s
FAO:
Report by:
Pupil Name:
UPN No:
School:
Date:
Time:
Duration:
Present:
FAO:
Report by:
Pupil Name:
UPN No:
School:
Date:
Time:
Duration:
Present:
FAO:
Report by:
Pupil Name:
UPN No:
School:
Date:
Time:
Duration:
Present:
Note: On subsequent pages of Intervention Visit Running Records, it is important to complete the relevant FAO/Report/Pupil/School at least once on each sheet, to ensure partial records are correctly maintained.

SEN Specialist Support ROSI Revised (Std) v3 Sept 2013 1

( c ) R e v i e w a n d E v a l u a t I o n
Date of Review
Attendance
Review details:
Feedback given to school / family / other professionals
Key actions to be taken forward:
Copy of ROSI distributed to: (Please tick and date when sent)
MainstreamSchool / EMSSchool File
WISDOM File /
Other (Specify): / Specialist Support (Autism) only:

Disclaimer: A database has been created from the questions on this form. Please do not amend any of the
questions in any way, as this may result in your data not being captured.

SEN Specialist Support ROSI Revised (Std) v3 Sept 2013 1