Nanny Childcare Reference Form
General Information

Your Name:
Your Email Address:   Telephone #:
Nanny Name:

How do you know this nanny?


How long have you known her/him?


Are you related to her/him and if so, how?


Is this a childcare reference (i.e., evaluating childcare services and abilities)? Yes No
If yes, explain.


This individual was:
our nanny our babysitter a daycare worker our child's teacher a camp counselor
other (Explain)



For Babysitters and Nannies

How many children do you have?

How old were they when she babysat/nannied for you?

If you have used this individual in the past for childcare, would you hire her again? Yes No
Explain.


How often did this individual watch your children, over what period of time, and for how
many hours at a time?


Did she ever watch your children all day long or overnight? Yes No
How often?
Explain.


Indicate the total number of hours this individual has spent watching your children,
either as babysitter or nanny, by checking the appropriate box below.  Think back and
include all experience from the time she first babysat for you.



For Teachers, Camp Counselors, and Day Care Workers

What specific services did she provide?


How many total hours did she spend providing these services and over what period of time?


How many children were involved?

Would you use her again for such services?


Rating the Nanny

How would you rate the individual on the following competencies?  (Possible ratings for each competency are "Excellent," "Very Good," "Good," "Fair," or "Poor.")

1) Is reliable? Excellent Very Good Good Fair Poor
Explain.

2) Relates well to children? Excellent Very Good Good Fair Poor
Explain.

3) Is attentive to the needs of the children? Excellent Very Good Good Fair Poor
Explain.

4) Is honest? Excellent Very Good Good Fair Poor
Explain.

5) Lives her values? Excellent Very Good Good Fair Poor
Explain.

6) Has sufficient energy to keep up with active children? Excellent Very Good Good Fair Poor
Explain.

7) Is a hard worker? Excellent Very Good Good Fair Poor
Explain.

8) As a babysitter or nanny, communicates effectively with parents about issues involving the children? Excellent Very Good Good Fair Poor
Explain.

9) Keeps commitments and completes the work she is responsible for? Excellent Very Good Good Fair Poor
Explain.


Other Questions

10) Have you ever observed this individual inappropriately discipline a child or take her frustrations out on a child? Yes No
Explain.

11) Has the prospective nanny ever been in trouble with the law? Yes No
Explain.

12) Does this individual have a temper, angry outbursts or difficulty managing emotions? Yes No
Explain.

13) How would you describe her personality?
Explain.

14) What is this individual like on a bad day, i.e., a day when things are not going well?
Explain.

15) Is she easy to work with? Yes No
Explain.

16) Is she organized and reasonably neat in her personal habits? Yes No
Explain.

17) Does she have any health problems that would make it difficult for her to perform her duties as a full time live-in nanny? Yes No
Explain.

18) Any negatives or concerns about her as a childcare provider?
Explain.

19) What attributes does she have that would make her effective as a nanny?
Explain.

20) How do you think this individual will do as a nanny? Excellent Very Good Good Fair Poor
Explain.