Information

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Select date

Medication Administration FFAC (local)

  • Principal designee for medication administration form completed and filed in Medication binder

  • Permission forms from parent/MD completed and filed in Medication binder

  • Medications organized and stored according to CFISD policy

  • Epinephrine auto-injectors stored in unlocked cabinet marked "Emergency Medications"

  • Permission for self-administration of medication completed and filed in appropriate binder

  • Administration of medication is documented daily in electronic medical record (EMR)

Office Visit Documentation

  • Thorough and appropriate documentation of assessment in narrative section of daily log entries

  • Thorough and appropriate documentation of interventions in narrative section of daily log entries

Immunization Documentation

  • Immunization compliance report is up to date (as medically possible)

  • Immunization exemption certificates and MD letters are filed in Exemption binder and documented in EMR

  • Documented parent/guardian notification of immunization requirements

  • Documented notice to campus administration concerning immunization non-compliance

Screening

  • Vision and hearing screening completed 120 days from student enrollment

  • Spinal and Acanthosis Nigricans screening completed by Spring break

  • Screening results documented in EMR

  • Documented monthly biological calibration of audiometer

  • Demonstrated knowledge of community assistance for vision exams including documented referrals when appropriate

Clinic Management

  • Clinic is orderly and free of clutter

  • Supplies are easily accessible

  • Otoscope, pulse ox., thermometer, and sphygmometer are in working order

Substitute Notebook

  • Organized according to CFISD guidelines found in health services handbook

  • Updated with current campus specific information including substitute spare key location

  • Current telephone lists with nearest campus RN phone numbers included

  • Current campus Alert & Disability roster included

Special Services

  • Documented campus staff health awareness education

  • Documented transportation health awareness education

  • Current IHPs for identified students

  • Current orders (updated annually) for special procedures in appropriate binder

  • Documented training for delegated procedures<br>

  • Documented supervision of delegated procedures

  • Principal UDCA delegation form signed and filed in Diabetes binder

  • Documented UDCA training filed in Diabetes binder

Emergency Preparedness

  • Evacuation plan in place

  • Emergency trauma bag properly stocked and easily accessible

  • Rolling cart to evacuate medications is easily accessible

  • AED checklists current (inspected monthly)

  • Documented evacuation training on file for 2 story campuses

Audit Results

  • Is follow up audit necessary?

  • When will follow up audit take place?

  • Auditor's Signature

  • Additional Remarks

  • Campus Registered Nurse Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.