• Clinic Visit Report

  • Nurse:

  • Area assignment:

  • School:

  • School:

  • School:

  • School:

  • Date/Time:

  • Visit Completed By:

  • This visit was:

Visit Checklist

Clinic Environment

  • Clinic is a nonhazardous environment (free of spills, clear traffic pattern, body fluids cleaned immediately).

  • Emergency Bags are easily accessible and properly stocked.

  • Is the 2nd Emergency bag stored in a location away from the clinic (in case of the event that the clinic was inaccessible)?

  • Campus crisis plan and white emergency flip chart are available and the role of the nurse is understood.

  • Student health concerns are easily identifiable and accessible.

  • Are health cards and student health information forms able to be locked up (locking file cabinet or clinic door)?

  • Does the nurse have an updated notebook/written plan for substitutes to follow?

  • Are parent emergency phone numbers easily accessible?

  • Is the nurse properly identified as a registered nurse?

  • Is the nurse using the most up-to-date forms (special procedure forms, staff training forms, accident reports, etc)?


  • Are school AED(s) accessible to all school personnel during all hours (not stored in locked room or cabinet)?

  • Are AED location signs posted in the school?

  • Is each AED notebook up-to-date regarding the daily/monthly maintenance checks?

  • Are the AED pads current (non-expired)?

  • Are the correct pad expiration dates listed in the AED notebook?

  • Is there a list of current personnel with valid certification expiration dates on the AED sheet?


  • Are medications* stored out of reach of children in a locked cabinet? (*except for epinephrine injectors)

  • Are emergency diabetic supplies and anaphylaxis medications easily accessible in a secure but unlocked location?

  • Are they labeled in such as way as to be located quickly by staff?

  • Are inhalers stored in a manner that would be easily removed and carried during a fire/other emergency?

  • Do all medications have a completed and signed Parent/Physician Authorization to Administer Medications form?

  • Are all prescription medications in their original container and properly labeled with a pharmacy label that matches the Parent/Physician Authorization to Administer Medications form?

  • Are all OTC meds in their original container and properly labeled with the student's first and last name?

  • Are medications being signed off as given with the time and initials of administrator on the RISD Med form?

  • Have all personnel administering medications signed off on the Medication Signature sheet?

  • Is an up-to-date medication check-off sheet being utilized?

  • Pull up this week's medication checklist in Star Student. Compare this checklist with the one being used in the med book. Have all medications been entered into Star Student (student Medication tab)?

  • Are PRN meds listed correctly? (Should be in their own table and not mixed in with the scheduled meds.)

  • Are there any meds listed from previous school years that should be closed out in the record?

  • If there have been missed medications or medication errors, has the nurse completed and submitted incident reports to the Director of Health Services?


  • Have clinic visits been entered into Star Student?

  • Does documentation include history of complaint, assessment, intervention, and evaluation?

  • Consistently entered in a timely manner (within 3 days)?

  • Is the nurse maintaining hard copies of the clinic passes and/or sign-in sheets if utilized?

  • Are they kept in an organized fashion that is easily understood/accessible to office staff, while maintaining confidentiality?

  • Have student health conditions been entered into Star Student (Disease tab)?

  • Has the nurse entered details about the health conditions (not just the disease codes)?

  • Is an EFFECTIVE documentation method in place when the nurse is out of the building?

  • Are Individualized Healthcare Plans in place for pertinent students?

  • Was the auditor able to review an IHP during the visit?

  • Will a time be arranged to provide the nurse feedback regarding an IHP prior to his/her evaluation?

  • Describe the quality of the health history and assessment sections.

  • Notes:

  • Did the nurse identify appropriate needs and risks for the specific student/family?

  • Did the nurse develop individualized, measurable goals for the student/family?

  • Are the interventions for each goal individualized?

  • Are the expected outcomes measurable and specific to the interventions listed? (not just a restatement of the overall goal)

  • Has the nurse made any progress notes since the care plan was developed (electronically or hand-written)?


  • Does the nurse have an effective system in place with the office staff for enrolling students (with regard to shot records and health concerns)?

  • Does the nurse have a process in place to routinely monitor immunization compliance?

  • Are there students enrolled at the campus that have a CO or medical exemption (1M or LM)?

  • Are the original exemption documents filed in the students' CUM folders?


  • Hearing/Vision/AN screening

  • Have rechecks been completed?

  • Is progress on referrals being documented?

  • Has student data been entered/updated in the ANTES system?

  • Scoliosis Screening

  • Growth & Development / HIV classes

  • Has a Campus Food Allergy Management Team been set up for this year?

  • Has the Team had at least one meeting this year?

  • Has a date been set for the meeting?

Additional Comments

Equipment & Reference Materials

Clinic Equipment

  • Does the clinic have a functioning...

  • Temporal thermometer?

  • Oral thermometer?

  • Stethoscope (in addition to ones in emergency bags)?

  • Nebulizer?

  • Pulse Oximeter?

  • Large Adult Blood Pressure cuff (in addition to ones in emergency bags)?

  • Adult Blood Pressure cuff (in addition to ones in emergency bags)?

  • Pediatric Blood Pressure cuff (in addition to ones in emergency bags)?

  • Automatic Blood Pressure monitor (optional)?

  • Wall mounted Stadiometer?

  • Scale

  • Wheelchair

Reference Materials

  • Blood-borne Pathogens Manual

  • Community Council Resources

  • Year

  • Davis Drug Guide

  • Dermatology

  • Drug ID Bible

  • Growth & Development materials

  • Essentials of Musculoskeletal Injuries

  • Medical Dictionary

  • Merck Manual

  • Health Care Plans for School Nurses

  • Health Services Manuals

  • Minor Emergencies

  • PDR

  • Year

  • Redbook

  • Year

  • Special Procedures (purple spiral)

  • Sports First Aid

  • Whaley and Whong

  • Yellow School Health Emergencies Book


  • School Nurse

  • Auditor

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