WINDSOR C-1
SCHOOL DISTRICT
Student Allergy
Prevention and Response
Policy
FILE: JHCF
Critical
STUDENT ALLERGY PREVENTION AND RESPONSE
INTRODUCTION
Windsor C-1 School District is committed to providing a safe and nurturing environment for
students and understands the increasing prevalence of life threatening allergies among the
school population. Recognizing that the risk of accidental exposure to allergens can be
reduced in the school setting, Windsor C-1 School District is committed to working in
cooperation with parents, students, and licensed healthcare providers, to minimize risks
and provide a safe educational environment for all students. The focus of allergy
management shall be on prevention, education awareness, communication and emergency
response.
PURPOSE
This document will provide guidelines for Windsor C-1 School District parents and staff
regarding allergies. The goal is to develop appropriate procedures to reduce the risk of
accidental exposure to those allergens that can be life threatening or cause anaphylactic
reactions of students in our buildings. It is impossible to create an allergen-free
environment. To create the illusion that the school environment is free of allergens would
be misleading and potentially harmful. Instead, this policy has been designed to increase
awareness and communication, to prevent possible exposure to identified allergens, and to
create an emergency procedure for allergic reactions.
IDENTIFICATION
Each school will attempt to identify students with life threatening allergies, including food
allergies. At enrollment, the person enrolling the student will be asked to provide
information on any allergies the student may have.
PREVENTION
Students with allergies that rise to the level of a disability as defined by law will be
accommodated in accordance with district policies and procedures pertaining to the
identification and accommodation of students with disabilities. An Individualized Health
Plan (IHP) may be developed for students with allergies that do not rise to the level of a
disability.
All staff members are required to follow any Section 504 Plan or IHP developed for a
student by the district. Staff members who do not follow an existing Section 504 Plan or
IHP will be disciplines, and such discipline may include termination.
Staff members are prohibited from using cleaning materials, disinfectants, pesticides or
other chemicals except those approved by the district.
The district will not serve any processed foods, including foods sold in vending machines,
which are not labeled with a complete list of ingredients. Vended items must include a list of
ingredients on the individual package. The food service director will create an ingredient list
for all foods provided by the district as part of the district’s nutrition program, including food
provided during the school day and in before and after school programs. This list will be
available upon request.
Prepackaged items used in concessions, fundraisers and classroom activities must include
a list of ingredients on the package. If the package does not contain a list of ingredients, the
list of ingredients must be available at the location where the package is sold or provided.
EDUCATION AND TRAINING
Staff members will be regularly trained on the causes and symptoms of and responses to
allergic reactions. Training will include instruction on the use of epinephrine premeasured
auto-injection devices.
Age appropriate education on allergies and allergic reactions will be provided to students
as such education aligns with state Grade-Level Expectations (GLEs) for health education.
Education will include potential causes, information on avoiding allergens, signs and
symptoms of allergic reactions and simple steps students can take to keep classmates
safe.
CONFIDENTIALITY
Information about individual students with allergies will be provided to all staff members and
others who need to know the information to provide a safe learning environment for the
student. Information about individual students with allergies will be shared with students
and others who do not have a legitimate educational interest in the information only to the
extent authorized by the parent/guardian or as otherwise permitted by law, including the
Family Educational Rights and Privacy Act (FERPA).
RESPONSE
Response to an allergic reaction shall be in accordance with established procedures,
including application of the student’s Section 504 Plan or IHP. Information about known
allergies will be shared in accordance with FERPA. Each building will maintain an adequate
supply of epinephrine premeasured auto-injection devices to be administered in
accordance with Board policy.
FILE: JHCF-AP2
Critical
STUDENT ALLERGY PREVENTION AND RESPONSE PROCEDURES
PARENT/GUARDIAN RESPONSIBILITES
1. Teach your child to take responsibility for his/her own safety by doing the following:
a. Recognize the first symptoms of a food allergic/anaphylactic reaction.
b. Communicate with the school staff as soon as he/she feels a reaction is starting.
c.
Carry his/her own epinephrine auto-injector when appropriate and approved by the district.
d. Do not share snacks, lunches, drinks or utensils.
e. Understand the importance of hand washing before and after eating.
f.
Encourage education on label reading and ingredient safety.
2. Inform the school nurse of your child’s allergies prior to the opening of school (or as soon as possible
after diagnosis) and keep emergency contact information current. All food allergies must be
verified from a licensed health care provider. If food substitutions are required, the Medical
Statement Requiring Special Meals form must also be completed by a licensed healthcare
provider. Consultation with the school nurse is required before accommodations with the food
service department are made.
3. Provide prescribed medication to the school nurse, following the medication policy (JHCD CRITICAL),
on the first day your child enters school.
4. Provide an Allergy Action Plan (AAP) from the child’s treating licensed healthcare provider.
5. Inform the school nurse of any changes in your child’s health status.
6. Provide the student’s teacher with extra snacks for unplanned events.
7. Provide the school nurse with a physician statement if the child no longer has food allergies.
STUDENT’S RESPONSIBILITIES
1. Do not trade or share food with others.
2. Wash hands before and after eating.
3. Do not eat foods known to contain allergens or anything with unknown ingredients.
4. Notify an adult immediately if you eat something you believe may contain the food to which you are
allergic, and/or if you believe you are having any symptoms of an allergic reaction.
5. Notify an adult if you are being picked on or threatened by other students as it relates to your food
allergy.
6. Students may carry and self-administer epinephrine or other necessary medication in accordance
with policy JHCD.
SCHOOL ADMINISTRATORS’ RESPONSIBILITIES
1. Follow all applicable federal laws, including ADA, Section 504, and FERPA, as well as all state laws
and district policies/guidelines that may apply.
2. Monitor satisfaction of cleaning protocol for classrooms, cafeteria, and other areas in the building.
3. Establish a procedure for how and when school staff should communicate with the main office and
school nurse in the event of an emergency.
4. Ensure that no food or consumption will take place in any classroom for instructional purposes unless
the instructor has permission from the building administrator. Courses that include food preparation or
consumption as a regular part of the curriculum are exempt from this provision, but instructors in
these courses have an increased responsibility to monitor student adherence to prevention
procedures.
5. All staff should be responsible for personal food consumption within the school setting with
consideration to students with life-threatening food allergies.
6. Enforce the Shared Food Policy (EFEA BASIC).
7. Discourage consumption of food on routine bus routes. Food may be allowed on longer trips with
appropriate supervision. Students being transported to and from activities on the bus may be allowed
to consume food and beverages if the staff member serving as sponsor has verified that none of the
students being transported have documented life-threatening food allergies.
8. Establish within the cafeteria designated tables for the restriction of specific foods.
9. Ensure that the school nurse provide a regular educational program for building staff on lifethreatening allergies. This training will be conducted at the beginning of the school year and as
needed with new employees. More extensive training will be provided to staff members who are
responsible for students with specific identifiable medical conditions.
10. All IHPs are available in the nurse’s office and a copy is given to all classroom teachers. If a child is
found eligible for a 504, a copy of the IHP is attached and given to the teacher. A copy of the 504/IHP
will be in the guidance counselor’s office.
11. Ensure that staff members submit a list of students taking part in off-site activities, such as
competitions and field trips, to the nurse at least three (3) days prior to the activity. The nurse will
verify which, if any, students have allergies and provide the staff member with a copy of the
IHPs/504s and any student’s medications that may be needed in the case of an allergic reaction.
12. Age-appropriate education on allergies and allergic reactions will be provided to students as such
education aligns with state Grade-Level Expectations (GLEs) for health education.
NURSES’ RESPONSIBILITIES
1. Develop
an
IHP
that
corresponds
with
the
Allergy
Action
Plan
(AAP)
provided
by
parents/guardians/licensed healthcare provider. This information will also be used to develop a
Section 504 plan, if needed. Information provided by parents/guardians/licensed healthcare provider
should be available prior to school entry or at first opportunity following a new diagnosis of a lifethreatening allergy. To ensure students’ confidentiality, plans will be shared with personnel on a need
to know basis.
2. IHPs and/or Section 504 plans will be developed, maintained and updated as needed. Open
communication will be maintained between home and school. The guidance counselor will be
contacted to start the 504 evaluation process.
3. Regular in-service training and education will be provided for all staff regarding identifying symptoms,
risk reduction and emergency procedures. Training will include instruction on the use of epinephrine
premeasured auto-injection devices. The school nurse shall retain documentation of those staff
members who have received regular training. Staff members who are hired after this training has
been conducted will be provided the information during their orientation. More extensive training will
be provided to staff members who are responsible for students with specific identifiable medical
conditions.
4. Maintain a list of students who require epinephrine auto-injectors for allergic reactions in the Health
Office. IHP’s, AAP’s and Section 504 plans for those students will be easily accessible to substitute
nurses.
5. A contingency plan will be in place and overseen by the building administrators in the event the nurse
is not in the building via utilization of trained and identified back-up personnel.
6. After a reaction has occurred, it is important to review policies and procedures among the school
staff, the student’s healthcare provider, parents, and the student.
TEACHERS’ RESPONSIBILITIES
1. Knowledge of the signs and symptoms of a severe allergic reaction as provided in the student’s
IHP/AAP/Section 504 plan. Be aware of and implement the emergency plan, if a reaction is
suspected.
2. Participate in in-service training on life-threatening allergies including demonstration on how to use
the Epinephrine premeasured auto-injectors. More extensive training will be provided to staff
members who are responsible for students with specific identifiable medical conditions. Verification of
training will be required.
3. Encourage proper hand washing before and after eating.
4. Ensure that no food or consumption will take place in any classroom for instructional purposes unless
the instructor has permission from the building administrator. Courses that include food preparation or
consumption as a regular part of the curriculum are exempt from this provision, but instructors in
these courses have an increased responsibility to monitor student adherence to prevention
procedures.
5. All staff should be responsible for personal food consumption and use of fragrances within the school
setting with consideration to students with allergies.
6. In collaboration with the nurse and parents/guardians of the allergic student, set a classroom plan
regarding the management of food in the classroom. This plan will be communicated by the teacher
to the students and parents/guardians of the affected classroom.
7. Notify parents by written communication of any school-related activity that requires the use of food in
advance of the project or activity (i.e. classroom parties, classroom rewards).
8. Staff members must submit a list of students taking part in off-site activities, such as competitions and
field trips, to the nurse at least three (3) days prior to the activity. The nurse will verify which, if any
students have allergies and provide the staff member with a copy of the relevant Section 504 plans,
IHPs/AAPs and any student’s medications that may be needed in case of an allergic reaction.
9. Classroom teachers will carry IHP/AAP/Section 504 plan and medications, as designed by the school
nurse, for field trips.
FOOD SERVICES’ RESPONSIBILTIES
1. The food services’ director will arrange for all food service staff to be trained in food label reading,
cross-contamination avoidance, safe food handling and food item labeling requirements. The school
nurse will provide education on managing life-threatening allergies, including the use of epinephrine
premeasured auto-injector devices.
2. Thoroughly clean all tables, chairs and floors after each meal.
3. After receiving the Medical Statement for a Student Requiring Special Meals form and in accordance
with USDA guidance, the Windsor C-1 School District Food Service Department will make reasonable
modifications, as feasible, for meals served to students with food allergies.
4. Food service employees will wear non-latex gloves.
5. Maintain a list of students with food allergies within the food service area with a photo of the student
wherever possible.
6. Establish within the cafeteria designated tables for the restriction of specific foods.
7. Consultation with the school nurse is required before accommodations with the food service
department are made.
CUSTODIAL RESPONSIBILITIES
1. Use a separate wash bucket and cloth with district-approved cleaning agents solely for the cleaning
of designated tables for the restriction of specific allergens.
2. Receive training on allergen zone maintenance areas.
3. The school nurse will provide education on managing life-threatening allergies, including the use of
epinephrine premeasured auto-injector devices.
TRANSPORTATION RESPONSIBILITES
1. Provide regular training for school bus drivers on managing life-threatening allergies, including the
use of epinephrine premeasured auto-injector devices.
2. Provide functional emergency communication device (e.g. cell phone, two-way radio, walkie-talkie or
similar device).
3. Know how to activate Emergency Medical Services (EMS).
4. Except as otherwise outlined in this procedure, drivers will not allow students to eat or drink on district
transportation unless the student has written permission from his or her principal. Written permission
will be provided if the student has a medical need to consume food or beverages during the time the
student is transported. A student who has a medical need to consume food or beverages on district
transportation must have a Section 504 plan or IHP that addresses which food or beverages the
student may consume if he or she is transported with any other student who has a life-threatening
food allergy. Students being transported to and from activities on district transportation may be
allowed to consume food and beverages if the staff member serving as sponsor has verified that
none of the students being transported have documented life-threatening food allergies.
5. Bus drivers will not hand out food treats even on special occasions.
PERSONS IN CHARGE OF CONDUCTING AFTER SCHOOL ACTIVITIES
1. The school nurse will provide copies of Section 504 plans or IHPs to personnel in charge of after
school activities. In order to provide this, a list of students has to be provided to the school nurse (i.e.
coaches, latchkey and clubs). These personnel will maintain a list of students with severe lifethreatening allergies.
2. Check with building nurse on location of emergency medications.
RESPONSIBILITIES DURING RECESS
1. A list will be provided by the school nurse on the students with life-threatening food allergies.
2. Emergency communication device will be functional and accessible.
FIELD TRIP RESPONSIBILITES
1. Meals of students with food allergies should be stored separately to minimize cross contamination.
2. Copies of the Section 504 plans or IHP/AAP will be sent with the student’s medication.
3. Staff will call 911 in all instances of epinephrine use, and parents/guardians will be notified.
4. Consideration will be given for avoiding food allergen exposure on field trips. Parental attendance is
encouraged.
FILE: JHCF-AF1
Critical
STUDENT ALLERGY PREVENTION AND RESPONSE
(Allergy Action Plan – Physician Statement)
Allergy to: ______________________________________________________________________________
Student: ___________________________ DOB: ____________ GR: __________ Teacher: _____________
Does student have history of asthma?
Yes
No
Signs of an allergic reaction specific to your child: _______________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
For Minor Reaction (Check all that apply.)
1.
If symptoms are: ______________________________________________________________, give
(medication, dose, route) ___________________________________________________________.
2.
Call emergency contacts below.
3.
Call physician below for further directions.
For Major Reaction (Check all that apply.)
1.
If symptoms are: ______________________________________________________________, give
(medication, dose, route) _______________________________________________IMMEDIATELY.
2.
Call EMS.
3.
Call emergency contacts below.
4.
Call physician below for further directions.
DO NOT HESITATE TO CALL EMS
Additional information that you want the school to consider pertaining to your child’s allergies:
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Physician’s Signature: ________________________ Parent Signature: _____________________________
Date: _______________ Phone: _______________ Date: _______________ Phone: _________________
EMERGENCY CONTACTS
1. _____________________________________________
2. _____________________________________________
Relation: _______________________________________
Relation: _______________________________________
Phone: ________________________________________
Phone: ________________________________________
Phone: ________________________________________
Phone: ________________________________________
For Office Use Only: JHCF-AF1.WSR (11/10)
Page 1
FILE:
JHCF-AF1
Critical
TRAINED STAFF MEMBERS TO ADMINISTER PERMEASURED EPINEPHRINE
(If any, in addition to any building school nurse)
1. ___________________________________________
2. ___________________________________________
Room: _______________________________________
Room: _______________________________________

Note: The reader is encouraged to review policies and/or procedures for related information in
this administrative area.
Implemented:
02/23/2011
Revised:
04/15/2011
Windsor C-1 School District, Imperial, Missouri
Page 2
For Office Use Only: JHCF-AF1.WSR (11/10)
FILE: JHCF-AF4
Critical
STUDENT ALLERGY PREVENTION AND RESPONSE
(Epinephrine Medication Self-Administration)
Student Name: ________________________________________ Grade: _______ School Year: ________________
The Missouri Safe Schools Act of 1996 provides for students to carry self-administer lifesaving medications when the following criteria are met:
1.
A licensed physician prescribed or ordered the medication for use by the child and instructed such child in the correct responsible
use of the medication.
2.
The child has demonstrated to the child’s licensed physician or the licensed physician’s designee, and the school nurse, if
available, the skill level necessary to use the medication and any device necessary to administer such medication prescribed or
ordered.
3.
The child’s physician has approved and signed a written treatment plan for managing asthma or anaphylaxis episodes of the child
and for medication for use by the child. Such plan shall include a statement that the child is capable of self-administering the
medication under the treatment plan.
4.
The child’s parent or guardian has completed and submitted to the school any written documentation required by the school,
including the treatment plan required in (3) above and the liability statement required in (5) below.
5.
The child’s parent or guardian has signed a statement acknowledging that the school district and its employees or agents shall
incur no liability as a result of any injury arising from the self-administration of medication by the child or the administration of such
medication by school staff. Such statement shall not be construed to release the school district and its employees or agents from
liability for negligence. (Missouri Revised Statute: Chapter 176; Pupils and Special Services; Section 167.627;08-28-2006).
Medication Name: __________________________ Dose: __________________ Time or Interval: _________________________________
Route/Inhalation Device: ______________________ Instructions: ______________________________________________________________
Medication Name: __________________________ Dose: __________________ Time or Interval: _________________________________
Route/Inhalation Device: ______________________ Instructions: ______________________________________________________________
Allergies (List known allergies to medications, foods or air-borne substances.)
_____________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
I, the parent or legal guardian of the student listed above, give permission for this child to carry and self-administer the above-listed
medications. I have instructed my child to notify the school staff anytime this device is used. I understand that, absent any negligence,
the school shall incur no liability as a result of any injury arising from the self-administration of medication by my child.
Signature of Parent or Legal Guardian: ___________________________________________ Date: __________________________
Parent/Guardian:
Name: _________________________________________ Home Phone: _________________________________________________
Address: _______________________________________ Work and Cell Phones: _________________________________________
Name: _________________________________________ Home Phone: _________________________________________________
Address: _______________________________________ Work and Cell Phones: _________________________________________
Emergency Contact:
Name: _________________________________________ Phone #’s: ___________________________________________________
I, a licensed physician or nurse practitioner, certify that this child has a medical history of severe allergic reactions, has been trained in
the use of the listed medication, and is judged to be capable of carrying and self-administering the listed medication(s). The child should
notify school staff anytime the medication/injector is used. The child understands the hazards of sharing medications with others and
has agreed to refrain from this practice.
Signature of Healthcare Provider: ____________________________________________________________ Date: _____________________
Name of Healthcare Provider: _________________________________ Phone: _______________________ Fax: ________________________
Address: __________________________________________________ City: _________________________ Zip: ________________________

For Office Use Only: JHCF-AF4.WSR (11/10)
Page 1
FILE: JHCF-AF4
Critical
Note: The reader is encouraged to review policies and/or procedures for related information in
this administrative area.
Implemented: 02/23/2011
Revised:
04/15/2011
Windsor C-1 School District, Imperial, Missouri
Page 2
For Office Use Only: JHCF-AF4.WSR (11/10)
FILE: EFEA
BASIC
DISTRIBUTION OF NON-COMMERCIAL FOODS
(Shared Foods in the School Environment)
In the interest of providing a safe and healthy environment, the Windsor C-1 School District
prohibits the consumption of shared foods during the school day. Some medical conditions
and allergic reactions to food ingredients pose a serious risk to student safety. This risk is
higher when food ingredients are unknown or when appropriate food preparation conditions
cannot be controlled. Therefore, only prepackaged foods with nutritional labeling may be
brought to school for student consumption. Home-prepared foods are not permitted or sold
to students during the school day. This policy does not pertain to students’ individual
lunches and /or snacks brought from home for personal consumption.
Student Allergy Prevention and Response Policy
Parent Signature Page
Please sign on the line below acknowledging that you have read and understand the
Windsor C-1 School District’s Student Allergy Prevention and Response Policy. If you have
any questions, please contact the principal or school nurse.
___________________________________________
Parent Signature
___________________________________________
Parent Printed Name
_____________________
Date