Client Safety

Surrey Place wants me to be safe. They want to help me learn about safety. Here are some things I can do to stay safe.

I know the Surrey Place Client Bill of Rights. I will be a part of planning my services and making choices.

If I am not feeling well on the day of my appointment, I can call Surrey Place or my Surrey Place worker. They will tell me if I should come to Surrey Place.

I will tell Surrey Place if I am taking medications. I will bring a list of my medications and let them know if anything changes.

I will tell someone at Surrey Place if I fall or hurt myself. They will help me and tell me what to do.

Everyone should be treated with respect. Rude words or actions are not allowed at Surrey Place.

I should always feel safe in my body and my feelings. I can ask questions and tell Surrey Place what will make me feel safe.

I will tell Surrey Place if I have a medical condition or allergy. I will let them know how they can help.

To stop the spread of germs, I will wash my hands with soap and water or use hand sanitizer. I will wash my hands when I enter the Surrey Place building, or if someone suggests I should.

I will tell Surrey Place if I am worried about my safety. We need to work together to stay safe.

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Startle in response to loud noises?	YES NO
Turn to where a sound is coming from?	YES NO
Make different cries for different needs (hungry, tired)?	YES NO
Watch your face as you talk?	YES NO
Smile/laugh in response to your smiles and laughs?	YES NO
Imitate coughs or other sounds such as ah, eh, buh	YES NO

Respond to their name?	YES NO
Respond to the telephone ringing or a knock at the door?	YES NO
Understand being told no?	YES NO
Get what they want through using gestures (reaching to be picked up)?	YES NO
Play social games with you (Peek-a-Boo)?	YES NO
Enjoy being around people?	YES NO
Babble and repeat sounds such as babababa or duhduhduh?	YES NO

Follow simple one-step directions (sit down)?	YES NO
Look across the room to a toy when adult points at it?	YES NO
Consistently use three to five words?	YES NO
Use gestures to communicate (waves hi/bye, shakes head for no)?	YES NO
Get your attention using sounds, gestures and pointing while looking at your eyes?	YES NO
Bring you toys to show you?	YES NO
Perform for social attention and praise?	YES NO
Combine lots of sounds together as though talking (abada baduh abee)?	YES NO
Show an interest in simple picture books?	YES NO

Understand the meaning of in and out, off and on?	YES NO
Point to more than 2 body parts when asked?	YES NO
Use at least 20 words consistently?	YES NO
Respond with words or gestures to simple questions (Where's teddy? What's that?)?	YES NO
Demonstrate some pretend play with toys (gives teddy bear a drink, pretends a bowl is a hat)?	YES NO
Make at least four different consonant sounds (p ,b, m, n, d, g, w, h)?	YES NO
Enjoy being read to and sharing simple books with you?	YES NO
Point to pictures using one finger?	YES NO

Follow two-step directions (Go find your teddy bear and show it to Grandma.)?	YES NO
Use 100 to 150 words?	YES NO
Use at least two pronouns (you, me, mine)?	YES NO
Consistently combine two to four words in short phrases (Daddy hat. Truck go down.)?	YES NO
Enjoy being around other children?	YES NO
Begin to offer toys to other children and imitate other children's actions and words?	YES NO
Use words that are understood by others 50 to 60 per cent of the time?	YES NO
Form words or sounds easily and without effort?	YES NO
Hold books the right way up and turn the pages?	YES NO
Read to stuffed animals or toys?	YES NO
Scribble with crayons?	YES NO

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By 2 months

By 6 months

By 9 months

By 12 months

By 18 months

By 2 years

By 30 months

By 3 years

By 4 years

Understand the concepts of size (big/little) and quantity (a little/a lot, more)?	YES NO
Use some adult grammar (two cookies, bird flying, I jumped)?	YES NO
Use over 350 words?	YES NO
Use action words such as run, spill, fall?	YES NO
Participate in some turn-taking activities with peers, using both words and toys?	YES NO
Demonstrate concern when another child is hurt or sad?	YES NO
Combine several actions in play (puts blocks in the train and drives the train, drops the blocks off.)?	YES NO
Put sounds at the beginning of most words?	YES NO
Use words with two or more syllables or beats (ba-na-na, com-pu-ter, a-pple)?	YES NO
Recognize familiar logos and signs involving print (Stop sign)?	YES NO
Remember and understand familiar stories?	YES NO

Understand who, what, where and why questions?	YES NO
Create long sentences using five to eight words?	YES NO
Talk about past events (trip to grandparents house, day at child care)?	YES NO
Tell simple stories?	YES NO
Show affection for favourite playmates?	YES NO
Engage in multi-step pretend play (pretending to cook a meal, repair a car)?	YES NO
Talk in a way that most people outside of the family understand what she/he is saying most of the time?	YES NO
Have an understanding of the function of print (menus, lists, signs)?	YES NO
Show interest in, and awareness of, rhyming words?	YES NO
Read to stuffed animals or toys?	YES NO
Scribble with crayons?	YES NO

Follow directions involving three or more steps (First get some paper, then draw a picture and give it to Mommy)?	YES NO
Use adult type grammar?	YES NO
Tell stories with a beginning, middle and end?	YES NO
Talk to try and solve problems with adults and with other children?	YES NO
Show increasingly complex imaginary play?	YES NO
Talk in a way that is understood by strangers almost all the time?	YES NO
Generate simple rhymes (cat-bat)?	YES NO
Match some letters with their sounds (letter b says buh, letter t says tuh)?	YES NO