HEALTH & SAFETY FORMS

 

 

ASBESTOS RELATED MATTERS

Sample Letter to Parents
A sample letter notifying parents of the condition of asbestos
(To be completed each school year)

 

SCHOOL SAFETY FORMS

Annual Report of School Disaster Plan
Due to the Office of Education by the first teacher/student contact day

 
Injury and Illness Prevention Program (IIPP)

Lockdown Checklist

Medication Policy - Sample

 

Playground Safety Checklist
Due to the Office of Education by the end of each academic quarter

 

Quarterly Safety Inspection Report
Due to the Office of Education by the end of each academic quarter

 

Record of Emergency Drills


School Emergency Preparedness Plan -
Sample


Quick Reference Emergency Procedures - Sample

This is a link to a quick reference emergency procedures template that schools can customize for use on their campus.  It is a Word document that is easy to work with.

Disaster Plan Information for Parent/Student Handbook - Sample

 

School Safety Committee Report
Due to the Office of Education by November 2

 

Staff Safety Training Roster
Due to the Office of Education by the end of each academic quarter

 

Staff Safety Training Roster For Small Schools
Due to the Office of Education by the end of the academic school year

 

What Have You Done to Make Your School Safer?
Due to the Office of Education June 2016

 

STUDENT HEALTH FORMS

Administration of Medication for CDC's
This form includes physicians's orders and parental permission

 

Administration of Medication for Schools
This form includes physician's orders and parental permission

 

Authorization for Release of Medical Information

 

Consent to Treatment  (Fillable)
To be completed for each student at the beginning of the school year

 

Consent to Treatment - For Field Trips and Special Events

 

Oral Health Assessment Form

Policy for Administering Emergency Treatment to Children with Severe Allergies
This form is available by contacting Steve Zurek at SECC Office of Education

 

Self-Medication Administration Consent Form
To be used for parent/guardian permission before student self-medication administration

 

Student Accident Insurance Claim Form


Student Injury Report

Click HERE for Guidelines


Student Medical Record
 
To be used for K-12 students

 

Student Vision/Hearing Screening Record


 

 

 

 
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