MEDICAL ALERT / ANAPHYLAXIS
CHECKLIST FOR SCHOOL ADMINISTRATORS
STUDENT NAME:
(First)
(Last)
(Date of Birth)
SCHOOL:
Use this checklist to determine that policy and guidelines have been addressed. Complete with parents,
classroom teachers and administration.
Information and Awareness












Request for Medical Alert/Anaphylaxis Conditions Information Form is completed and filed in
the office.
Request for Medication Administration at School Form completed and filed in the office.
Annually provide brochure “For Parents/Guardians of Students with Medical Alert/Anaphylaxis
conditions.”
Consult with Public Health Nurse for clarification of which conditions may need Medical Alert
procedures.
Call the Transportation Supervisor if additional training is required for a bus rider.
Provide one copy of the Medical Alert/Anaphylaxis Conditions Information Form for each
student who is a registered rider to the Transportation Supervisor after each update. A copy of
the Request for Administration of Medication should be provided if the student carries an
EpiPen®, or Twinject™, Allerject™ and may require a bus driver to administer medication.
Refer to www.BCSTA.org/anaphylaxis for additional resources and anaphylactic awareness/
avoidance strategies.
Copies of policy distributed to parents of children with Anaphylaxis.
Policy and guidelines reviewed/distributed to parents/staff.
In-service, including training in the use of auto-injector (EpiPen®, Twinject™, Allerject™) is
provided).
Custodian is advised of the student’s condition in order to make arrangement for classroom
cleaning if needed.
Classroom teachers and administration respond to incidents “bullying” aimed at students due
to their condition.
Communication








Letters are sent home to ask for cooperation to parents of children in the class.
Information is communicated to all parents regarding the concerns through letters, newsletters,
PAC, etc. Regular reminders should be sent throughout the school year (quarterly).
Information regarding alternate lunch ideas is circulated to parents and available at the office
on request.
Parents are requested to provide anaphylactic students with medic alert.
Communicate to the Director of Instruction or delegate the name of the person at school level
responsible for the school’s Medical Alert information.
Return all remaining medication to parents at end of school year.
Inform parents that when their child transfers to another school, the parent must meet with the
receiving school principal/vice principal to share pertinent medical alert information.
Report information regarding anaphylactic incidents to the Board of Education (to include
number of at-risk students and number of incidents).
Emergency Procedures







Colored picture of the student is attached to the Medical Alert/Anaphylaxis Conditions
Information or Diabetes Support Plan Form and posted in appropriate locations (parent
permission required).
Medical Alert/Anaphylaxis Conditions Form is completed.
Copies of Medical Alert/Anaphylaxis Conditions Information Form (must include emergency
response plan) are given to all personnel connected with the student and posted in the medical
room and staff room.
Instructions on the use of the auto-injector are posted in the student’s classroom and medical
room and staff room.
Auto-injectors (EpiPens®, Twinject™, Allerject™) are checked for expiry date.)
Parents are requested to provide back-up injectors (EpiPens®, Twinject™, Allerject™).
Describe recommended location for EpiPen®, Twinject™, Allerject™) (e.g. on person)

Backup Auto-injectors (EpiPens®, Twinject™, Allerject™) are stored in safe and
UNLOCKED accessible locations.
Classroom Procedures








Safe eating area procedures are established.
Alternate eating arrangements are made for students bringing food that endangers student(s)
with anaphylaxis.
Appropriate information is shared with classroom peers.
Procedures for holidays and special celebrations are established.
Procedures for field trips are established including transportation, extra medication, food,
activities, availability of cell phone, etc.
Hand washing procedures are established.
Information is placed in a visible location for TTOCs.
Custodian is advised of the student’s condition in order to make arrangement for classroom
cleaning if needed.
Allergy Awareness, Prevention and Avoidance Strategies
Awareness:
The school principal should ensure:

All school staff and persons reasonably expected to have supervisory responsibility of schoolage students and preschool age children participating in early learning programs (e.g. food
service staff, volunteers, bus drivers, custodians) receive training annually or bi-annually, in the
recognition of a severe allergic reaction and the use of single dose, single-use auto-injectors
and standard emergency procedure plans.

All members of the school community including substitute employees, employees on call,
student teachers and volunteers have appropriate information about severe allergies including
background information on allergies, anaphylaxis and safety procedures.

With the consent of the parent, the principal and the classroom teacher must ensure that the
student’s classmates are provided with information on severe allergies in a manner that is
appropriate for the age and maturity level of the students, and that strategies to reduce teasing
and bullying are incorporated into this information.
Posters which describe signs and symptoms of anaphylaxis and how to administer a single dose, single-use
auto-injector should be placed in relevant areas. These areas may include classrooms, office, staff room,
lunch room and/or the cafeteria.
Avoidance/Prevention:
Individuals at risk of anaphylaxis must learn to avoid specific triggers. While the key responsibility lies with
the students at risk and their families, the school community must participate in creating an “allergy-aware”
environment. Special care is taken to avoid exposure to allergy-causing substances. Parents are asked to
consult with the teacher before sending in food to classrooms where there are food-allergic children. The
risk of accidental exposure to a food allergen can be significantly diminished by means of such measures.
Given that anaphylaxis can be triggered by minute amounts of an allergen when ingested, students with
food allergies must be encouraged to follow certain guidelines:





Eat only food which they have brought from home unless it is packaged, clearly labeled and approved
by their parents (elementary schools).
If eating in a cafeteria, ensure food service staff understands the life-threatening nature of their allergy.
When in doubt, avoid the food item in question.
Wash hands before and after eating.
Not share food, utensils or containers.
Place food on a napkin or wax paper rather than in direct contact with a desk or table.
Non-food allergens (e.g. medications, latex) will be identified and restricted from classrooms and common
areas where a child with a related allergy may encounter that substance.
December 23, 2015
Ref: U:\SBO-ST-Data\SECTR JULY 2014\00100-00999 Administration\00650 Records Management District Forms\00650-20
Forms\MedicalAlertPrincipalschecklist10October 2014.docx