Campus Clinic


  • Clinic is neat, clean and orderly; storage areas are organized and uncluttered.

  • Gloves are readily accessible and latex-free

  • Disposable items are unexpired, undamaged, not discolored and latex-free (bandages, tape, etc.)

  • Sharps container is appropriately secured/stored and safely accessible when needed

  • Sub information sheet current

  • Supplies and information for special procedures, medications, diabetes care are easy to access/find, labeled

Emergency Preparedness

  • Blue Medical Bag visible/nearby med cart or other evacuation supplies.

  • Contents of bag are not expired

  • Equipment is properly assembled (BP cuffs, stethoscope, etc.)

  • C.A.T is in bag

  • Kerlix rolls (2 minimum)

  • Glucose gel

  • Clinic stock EpiKit is readily available/easy to find.

  • EpiKit syringe expiration date

  • EpiKit epinephrine expiration date

  • Diabetes evacuation kit (clear bag with glucose sources & backup meter) is stocked and stored in Med Cart or Blue Bag

  • Glucagon is stored in a readily accessible location, and can be easily taken with evacuation (recommend all glucagon in Med Cart for elementary & middle school)

  • Emergency seizure meds are stored in readily accessible location & easily taken for evacuation (recommend storage in Med Cart for elementary & middle school)

  • Medications are labeled with pink dots if high priority for evacuation, if time allows.

  • Campus RN has evacuated with medical supplies at least once/semester with campus evacuation drill [med cart (elementary & middle schools); med kit/box/diabetes kit (high schools); Blue Medical Bag; Med Binder; Winbook]

  • Winbook and charger are ready/available for evacuation

  • Student emergency information current and PDF stored on Winbook

  • Employee emergency information current/complete and PDF stored on Winbook

  • RN is wearing badge buddy with emergency procedures and evacuation instructions.

  • AED maintenance checks are current

  • Medical Emergency Response Team (MERT) identified/updated for current school year

  • Adequate number of MERT members have current CPR certification

  • MERT drill/training completed 1st semester drill scheduled or completed

  • Plan in place for entry into locked bathroom doors in clinic or other campus locations (hex/Allen key, coin, or other device); MERT/campus staff know procedure

  • Cafeteria manager has been provided food allergy list and completed special diet request forms

  • Teachers/staff have been provided food allergy information and assisted with classroom/campus food allergy safety procedures

  • Alert box and critical alerts have been entered/updated (Skyward)

Screening and Health Education/Promotion

  • Audiometer monthly biological checks are completed/up-to-date

  • Vision mass screening

  • Hearing mass screening

  • AN mass screening

  • Assessments done and documented in Skyward

  • Spinal mass screening (required in fall semester)

  • Hand washing signs posted on campus

  • Hand washing education; respiratory etiquette; cold & flu prevention

  • 5th grade boys & girls Growth & Development (Fall semester)


  • Affidavits (conscientious exemptions) are current and accurately documented in Skyward

  • Affidavits are scanned/attached in Skyward Portfolio

  • Original paper Affidavits are stored student's pink health file

  • Campus has a student with medical vaccine exemption

  • Medical exemption is accurately documented in Skyward (review statement: date signed by physician, good for one year or lifelong)

  • Medical exemption letters are scanned/attached in Skyward Portfolio

  • Original paper medical exemption letter is stored in student's pink file

Medication and Special Care


  • Medication keys and medication cabinets secured at time of walk through (visual inspection)

  • Principal medication assignment form is current and signed by Principal

  • Standing order medications are stocked

  • Current year's standing orders are posted in front of Med Binder

  • Standing order meds are not expired

  • Current student declination list is posted & visible near medications/treatment area

  • No unauthorized student-use unassigned medications are present

  • Expiration Log is up to date

  • Medication Worksheet is printed and being used

  • Student prescribed epinephrine is stored in a readily accessible location

  • Controlled medications are properly secured

  • All controlled medications (inventory sub-types) are tracked in Skyward ("Track Inventory" checked)

  • Weekly inventory documentation is current and no variances are noted

  • Inventory completed by campus RN and Health Services Administrator

  • Describe variance and reconciliation; complete written variance report form

Diabetes and Special Care

  • Diabetes supplies are readily available and clear plan in place for evacuation with supplies

  • UDCA assignment form current with all assigned UDCAs and signed by the Principal

  • All assigned UDCAs have completed initial training and posttest

  • UDCA skills training current and documented on diabetes care checklist

  • Transportation notifications have been completed for all students with diabetes that ride bus.

  • Transportation notifications have been sent for all students with special procedures or medically complex conditions that may require emergency intervention.

  • Supplies for special procedures are ready for evacuation (recommend storing one package of IC or TF supplies in Med Cart)

  • Delegated procedures

  • Competency training documented with minimum of 3 successful return demonstrations

  • RN is conducting supervisory visits and documenting student status in Skyward at least every 2 weeks

Professional Goals

  • Professional Goal is entered in Strive for current school year

Summative Comments and Staff

  • Additional comments/feedback

  • Audit completed with Campus RN:

  • Audit completed by:

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