Family information Nanny information

Name:

Address:

Phone:

E-mail:

Agreed work days & hours Days: From: Until:

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Important dates

Nanny’s Start Date of Employment

Nanny’s Annual Employment Anniversary Date

Date Family Will Complete Nanny Handbook By

Date Family Will Review Nanny Handbook with Nanny

Weekly salary Nanny weekly compensation of $ ___ , based on a __ hour work week.

Overtime is paid on hours in excess of ___ per week and is compensated at $ ___ per hour.

Weekend pay is paid on hours in excess of those listed above and is compensated at $ __ per hour.

Travel pay If family takes the nanny on vacation on a weekday, the added compensation for the extra hours worked

monday – friday will be $______ per hour or a flat fee of $____ per day. If the family takes the nanny on

vacation on a weekend, the added compensation for the extra hours worked saturday – sunday will be

$______ per hour or a flat fee of $ _____ per day.

Other unique benefits/perks

Nanny / Family Work Agreement

Time Off Sick/Personal Days:

Sick Day Policy:

Personal Day Policy:

Vacation: Please Specify # of

weeks and who chooses

Vacation Policy:

Holidays:

Missed Days Policy:

Request to Leave Early Policy:

Snow Day Policy:

Commute/Transportation:

Confidentiality Rules:

Job Description

Daily Schedule

Child Child Child Child Parents /Home

6 AM

7 AM

8 AM

9 AM

10 AM

11 AM

12 PM

1 PM

2 PM

3 PM

4 PM

5 PM

6 PM

7 PM

8 PM

9 PM

Rules for Nanny Regarding Children and Home

Daily Tasks for Nanny

Weekly Tasks for Nanny

Monthly Tasks for Nanny

Nanny Requests – Filled in by Nanny

Parent Signature

Nanny Signature

Date

Date

Child’s Information Sheet

Child’s Name (First, Middle, Last)

Nickname Age

Date of Birth SSN

Height: Weight:

Blood Type:

Medical Conditions:

Recent Surgeries:

Allergies:

Medications and dosage information

Medication:

Dosage Amount:

Time to Administer:

Notes:

Medications and dosage information

Medication:

Dosage Amount:

Time to Administer:

Notes:

Medications and dosage information

Medication:

Dosage Amount:

Time to Administer:

Notes:

Child’s Medical Information

Insurance information

Insurance Provider:

Insurance ID Number:

Group Number:

Insurance Phone:

Policy Holder Name:

Policy Holder Employer:

Insurance Address:

Doctor information

Doctor’s Name:

Address:

Phone:

Working Days/Hours:

Notes:

Hospital information

Preferred Hospital:

Address:

Phone:

Notes:

Dentist information

Dentist’s Name:

Address:

Phone:

Working Days/Hours:

Notes:

Personality Profile

What activities does this child like to do?

What toys does this child like to play with?

How can the nanny best engage this child? What can the nanny say or do to encourage interaction with this child?

Are there certain things this nanny should not do or say to this child?

What is this child’s bedtime or naptime ritual? What steps should the nanny follow when putting this child to bed?

What are the main pieces of this child’s daily schedule?

What are the main pieces of this child’s weekly schedule?

Child’s rules & discipline CHORES for this child are:

The best way to RESOLVE conflict for this child is:

(For example: Give two clear choices or give a time out to cool off)

POSITIVE reinforcements to encourage child to do what is asked of her/him

(For example: 30 minutes TV time, 30 minutes computer, extra dessert, extra book at bedtime)

NEGATIVE reinforcements when child does not do what asked of her/him

(For example: Take away TV, take away dessert, no books at bedtime)

TIME OUTS are to be used for:

(For example: Hitting siblings, bad language)

Nanny MAY CALL parents if the child does:

(For example: Please call mother if the child will not calm down)

School / Activities / Playdates

School information

School: Tel#:

Address: Fax#:

Teacher: Website:

Principal: Nurse:

Drop-off Pick-Up

Bus #: Bus Driver:

Activities Information

Activity:

Program:

Days:

Start Time: End Time:

Address:

Tel #: Contact:

Start Date: End Date:

What to Pack:

Car pool for this activity

To:

From:

Activities information, cont.

Activity:

Program:

Days:

Start Time: End Time:

Address:

Tel #: Contact:

Start Date: End Date:

What to Pack:

Car pool for this activity

To:

From:

Activity:

Program:

Days:

Start Time: End Time:

Address:

Tel #: Contact:

Start Date: End Date:

What to Pack:

Car pool for this activity

To:

From:

Activities information, cont.

Activity:

Program:

Days:

Start Time: End Time:

Address:

Tel #: Contact:

Start Date: End Date:

What to Pack:

Car pool for this activity

To:

From:

Activity:

Program:

Days:

Start Time: End Time:

Address:

Tel #: Contact:

Start Date: End Date:

What to Pack:

Car pool for this activity

To:

From:

Play Dates

Child’s Name: Telephone:

Parent’s Names:

Address:

Directions:

Notes:

Child’s Name: Telephone:

Parent’s Names:

Address:

Directions:

Notes:

Child’s Name: Telephone:

Parent’s Names:

Address:

Directions:

Notes:

Child’s Name: Telephone:

Parent’s Names:

Address:

Directions:

Notes:

Child’s Name: Telephone:

Parent’s Names:

Address:

Directions:

Notes:

Free Activities / Play Areas (These are areas where the child is allowed to go during free play time)

Activity Name:

Address:

Telephone: Hours:

Notes:

Activity Name:

Address:

Telephone: Hours:

Notes:

Activity Name:

Address:

Telephone: Hours:

Notes:

Activity Name:

Address:

Telephone: Hours:

Notes:

Activity Name:

Address:

Telephone: Hours:

Notes:

Parents’ Information

Parents’ Names:

Street Address:

Cross Streets:

City, State, Zip:

Mailing Address:

City, State, Zip:

Home Telephone:

Parent 1 Contact Details

Name:

Cell Phone:

Email:

Employer Name:

Employer Address:

Employer Phone:

Employer Fax:

Assistant:

Parent 2 Contact Details

Name:

Cell Phone:

Email:

Employer Name:

Employer Address:

Employer Phone:

Employer Fax:

Assistant:

Emergency Contacts

Family/Friend 1 Contact Details

Name:

Cell Phone:

Home Phone:

Email:

Address:

Employer Name:

Employer Phone:

Family/Friend 2 Contact Details

Name:

Cell Phone:

Home Phone:

Email:

Address:

Employer Name:

Employer Phone:

Family/Friend 3 Contact Details

Name:

Cell Phone:

Home Phone:

Email:

Address:

Employer Name:

Employer Phone:

Household Information

Security Information & Contact Details

Security Keypad Number:

Alarm Password:

Garage Door Password:

Security Company Name:

Security Company Phone:

Emergency Extra Keys are Located:

Utilities Location

Fuse Box Location:

Water Cut Off Valve Location:

Thermostat Locations:

Utility providers Account Number & Contact Details

Cable Provider:

Home Phone Provider:

Internet Provider:

Gas Provider:

Electricity Provider:

Water Provider:

Trash/Recycling Service:

Household Information

Household services Information & contact details

House cleaning:

Heating/ac repair:

Handyman:

Appliance repair:

Electrician:

Plumber:

Landscape:

Misc. Services Information & contact details

Audio/video repair:

Carpet cleaning:

Computer repair:

Contractor:

Driveway repair:

Fireplace maintenance:

Gutters:

Pest control:

Pool care:

Community services Information & contact details

Animal control:

Library:

Parks & recreation:

Place of worship:

Post office:

Town hall:

Household Information

Care & retail Information & contact details

Bakery:

Barber/salon:

Deli:

Drug store:

Dry cleaners:

Florist:

Grocery stores:

Hardware stores:

Office supplies:

Shipping center:

Veterinarian:

Other:

Other:

Other:

Other:

Child Care/General Rules for Nanny

Rules for child care in home

Rules for child care out of home

General house rules

General rules out of the home

Travel and Transportation Information

By Vehicle

Who is Allowed to Use the Vehicle

Days & Times Allowed to Use How Far Allowed to Go

Vehicle Insurance Provider:

Insurance Agent: Agent Phone:

Policy Holder’s Name: Policy Number:

Gas to be paid by:

Snacks to be paid by:

Vehicle Rules: (Examples: must use booster seat, visitors, food and drinks allowed)

By Subway / Bus

Who is Allowed to Use It Days & Times Allowed to Use How Far Allowed to Go

Lines allowed to use:

Fairs to be paid by:

Snacks to be paid by:

General rules: (Example: must sit by exit)

Travel and Transportation Information

By Cab / Taxi

Who is Allowed to Use It Days & Times Allowed to Use How Far Allowed to Go

Where allowed to go in cab/taxi:

Fairs to be paid by:

Snacks to be paid by:

General rules: (Examples: must use seatbelt, must bring car seat)

By Foot / Stroller

Who is Allowed Days & Times Allowed to Use How Far Allowed to Go

Snacks to be paid by:

General rules: (Examples: must bring diaper bag, must apply sunscreen if necessary, must bring water)

Purchasing Information Item to Buy:

Who is to Purchase:

Where to Purchase:

Amount to Spend:

Where Purchase is To Go:

Additional Notes:

Item to Buy:

Who is to Purchase:

Where to Purchase:

Amount to Spend:

Where Purchase is To Go:

Additional Notes:

Item to Buy:

Who is to Purchase:

Where to Purchase:

Amount to Spend:

Where Purchase is To Go:

Additional Notes:

Item to Buy:

Who is to Purchase:

Where to Purchase:

Amount to Spend:

Where Purchase is To Go:

Additional Notes:

Items to be Maintained by Nanny Please indicate whether item to be replaced weekly or monthly

Groceries

House Supplies

Baby/Child Supplies

Meal Guidelines

Family Weekday Meal Times

Nanny Weekday Meal Times

Prep Time Start Time Prep Time Start Time

Breakfast: Breakfast:

Lunch: Lunch:

Snack: Snack:

Dinner: Dinner:

Family Weekend Meal Times

Nanny Weekend Meal Times

Prep Time Start Time Prep Time Start Time

Breakfast: Breakfast:

Lunch: Lunch:

Snack: Snack:

Dinner: Dinner:

Weekday Preparation Weekend Preparation

Who Preps:

Who Preps:

Set Up:

Set Up:

Clean Up:

Clean Up:

Food Shopping

Who Does It?

How Often?

Petty Cash Available?

Limit To Spend:

Notes:

Food & Meal Time Rules Allergies/Special Dietary Needs by Family Member:

Food Likes/Dislikes by Family Member:

Rules for Meal Time for Family:

Rules for Meal Time for Nanny:

Snacks, Food Rewards, and Eating Out

Acceptable Snacks In The Home

Acceptable Snacks Out Of The Home

Child Name:

Child Name:

Child Name:

Child Name:

Child Name:

Child Name:

Acceptable Reward Treats

Child Name:

Child Name:

Child Name:

Child Name:

Acceptable Places To Eat Out

Place Allowed to Order Not Allowed to Order

Weekly Menu Planner Week of ______________________

Nanny Served on MONDAY Meal Options Breakfast: Notes:

Lunch:

Snacks:

Dinner:

Nanny Served on TUESDAY Breakfast Options Breakfast:

Lunch:

Snacks:

Dinner:

Nanny Served on WEDNESDAY Lunch Options Breakfast:

Lunch:

Snacks:

Dinner:

Nanny Served on THURSDAY Snack Options Breakfast:

Lunch:

Snacks:

Dinner:

Nanny Served on FRIDAY Dinner Options Breakfast:

Lunch:

Snacks:

Dinner:

Nanny Served on SATURDAY Dessert Options Breakfast:

Lunch:

Snacks:

Dinner:

Nanny Served on SUNDAY Special Instructions for Week Breakfast:

Lunch:

Snacks:

Dinner:

Daily Parent/Nanny Communication Log

For Date: ___________________ Child’s name: Child’s name: Child’s name:

Parent directions Nanny Notes Parents directions Nanny Notes parents directions

Nanny Notes

Am

Am

Am

School

School School

Activities

Activities

Activities

Meals

Meals

Meals

Pm

Pm

Pm

Notes

Notes Notes

Household notes

Cleaning Events Food

Baby Schedule Daily Log Baby’s Name: ____________ For Date:________________

Sleep Feeding Diapers Comments Awake Asleep RB LB Bottle Wet Dirty Meds (New food, play

time, crying spells, etc.) AM 6:_____ 6:______ 6:______ 6:_______ 6:____ _ 6:______ Dose________

Mins_____ Mins____ Ozs____ Med Name: _____________

AM 7:______ 7:______ 7:______ 7:_______ 7:______ 7:_______ Dose_________

Mins_____ Mins____ Ozs____ Med Name:_____________

AM 8:______ 8:______ 8:______ 8:_______ 8:______ 8:_______ Dose_________

Mins_____ Mins____ Ozs____ Med Name:____________

AM 9:______ 9:______ 9:______ 9:_______ 9:______ 9:_______ Dose_________

Mins_____ Mins____ Ozs____ Med Name:_____________

AM 10:______ 10:______ 10:______ 10:_______ 10:_____ 10:______ Dose_________

Mins_____ Mins____ Ozs____ Med Name:____________

AM 11:______ 11:______ 11:______ 11:_______ 11:_____ 11:______ Dose_________

Mins_____ Mins____ Ozs____ Med Name:_____________

PM 12:______ 12:______ 12:______ 12:_______ 12:_____ 12:______ Dose_________

Mins_____ Mins____ Ozs____ Med Name:____________

PM 1:______ 1:______ 1:______ 1:_______ 1:______ 1:_______ Dose_________

Mins_____ Mins____ Ozs____ Med Name:_____________

PM 2:______ 2:______ 2:______ 2:_______ 2:______ 2:_______ Dose_________

Mins_____ Mins____ Ozs____ Med Name:____________

PM 3:______ 3:______ 3:______ 3:_______ 3:______ 3:_______ Dose_________

Mins_____ Mins____ Ozs____ Med Name:_____________

PM 4:______ 4:______ 4:______ 4:_______ 4:______ 4:_______ Dose_________

Mins_____ Mins____ Ozs____ Med Name:____________

PM 5:______ 5:______ 5:______ 5:_______ 5:______ 5:_______ Dose_________

Mins_____ Mins____ Ozs____ Med Name:_____________

PM 6:______ 6:______ 6:______ 6:_______ 6:____ _ 6:______ Dose________

Mins_____ Mins____ Ozs____ Med Name: _____________

PM 7:______ 7:______ 7:______ 7:_______ 7:______ 7:_______ Dose_________

Mins_____ Mins____ Ozs____ Med Name:_____________

PM 8:______ 8:______ 8:______ 8:_______ 8:______ 8:_______ Dose_________

Mins_____ Mins____ Ozs____ Med Name:____________

PM 9:______ 9:______ 9:______ 9:_______ 9:______ 9:_______ Dose_________

Mins_____ Mins____ Ozs____ Med Name:_____________

PM 10:______ 10:______ 10:______ 10:_______ 10:_____ 10:______ Dose_________

Mins_____ Mins____ Ozs____ Med Name:____________

PM 11:______ 11:______ 11:______ 11:_______ 11:_____ 11:______ Dose_________

Mins_____ Mins____ Ozs____ Med Name:_____________

AM 12:______ 12:______ 12:______ 12:_______ 12:_____ 12:______ Dose_________

Mins_____ Mins____ Ozs____ Med Name:____________

AM 1:______ 1:______ 1:______ 1:_______ 1:______ 1:_______ Dose_________

Mins_____ Mins____ Ozs____ Med Name:_____________

AM 2:______ 2:______ 2:______ 2:_______ 2:______ 2:_______ Dose_________

Mins_____ Mins____ Ozs____ Med Name:____________

AM 3:______ 3:______ 3:______ 3:_______ 3:______ 3:_______ Dose_________

Mins_____ Mins____ Ozs____ Med Name:_____________

AM 4:______ 4:______ 4:______ 4:_______ 4:______ 4:_______ Dose_________

Mins_____ Mins____ Ozs____ Med Name:____________

AM 5:______ 5:______ 5:______ 5:_______ 5:______ 5:_______ Dose_________

Mins_____ Mins____ Ozs____ Med Name:_____________

____Hrs ____Hrs ______Ozs

____ Mins ____ Mins

Week of:

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Child:________ *School *Activities *Carpool

Child:________ *School *Activities *Carpool

Child:________ *School *Activities *Carpool

Parent:_______ *Meetings *Plans *Appointments

Parent:_______ *Meetings *Plans *Appointments

House: *Dinner *Cleaning *Errands *Appointments

Monthly Calendar

Month of: Sunday Monday Tuesday Wednesday Thursday Friday Saturday Notes

Notes: