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Special Dietary Needs - Forms and Checklists

This form can be used for a child with special dietary needs.

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  • Updated on: 13 March 2018
  • Version: 1.1.0
  • Settings: LDC, FDC, OOSH
  • Framework: General
  • Type: Premium
  • Format: pdf, word

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Special Dietary Needs Overview:

The Special Dietary Needs Template is to be used for Educators to keep track of children's dietary needs within their room.

When filled in this can be kept in a folder and referred to, to ensure that all Educators are aware of children with special dietary needs and considerations that need to take place when serving meals to them etc.

*This is not a medical dietary form - this form is a reminder for Educators on a child's special dietary needs.

This template includes:

  • Name Of Child
  • DOB
  • Room 
  • Days Of Attendance
  • Image
  • 6 options for dietary needs
  • List of foods/ingredients to avoid
  • Alternate foods that can be used
  • Symptoms of allergy/intolerance
  • Additional Notes/Comments
  • 2 Questions On Allergy Action Plan
  • Completed by
  • Date
  • Sign
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