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This feedback form includes a questionnaire designed to provide a written record of a child’s views and needs in respect of his or her experiences within an early childhood service.  

The questionnaire may be implemented by either a parent or teacher but the child’s responses should be discussed by both parties.

The feedback form belongs to the child and therefore should not be shared with other families or people outside of the child’s immediate circle of caregivers and teachers.  When implementing the questionnaire, depending upon the child’s age and level of comprehension it may be necessary to repeat the question or ask the child to show you what makes him/her happy, sad, etc.  During the interview show you are genuinely interested in the child and not judging his/her responses.

 

Questionnaire

Child’s Name:   _____________________________    Date: _______________________________

ECE Service: _______________________________   Interviewer/Recorder: ________________

 

1.       What makes you feel happy at this place (or the name that the child knows the ECE service by)? 

 


 


 

 

2.       What makes you feel sad at this place? 

 


 


 

  

4.       What things don’t you like here? 

 


 


 

 

5.        What things do you like doing the most here? – why? 

 


 


 

 

Thank you _______________  (child’s name) for telling me about: 

 


 


 


(this is the adult’s summary)

 

Next Steps

A copy of the child’s feedback should be provided to the child’s ECE service or the ECE service should provide a copy to the family so that both parties have a copy.

The ECE service should set a time with the family to meet and discuss the feedback together (child included). 

At the meeting the family and ECE service representative/s should discuss what actions can be taken immediately and over the coming weeks and months to support the child and to improve the quality of the child’s experience.  From this discussion an action-plan should be prepared by the EC service representative that details any changes and specific actions to be taken, by whom, and includes time-lines and date for review.

The action-plan if liked and agreed to by all parties should be signed and dated.  It should be kept and referred to over the time-frame of implementation and review.