First Aid - Administration of Medication record - duplicate

• Site conducted

  Select

• Date and time of report

  Date

• Child's full name

• Centre location

Child's details

• Child's date of birth

  Date

Medication and witness details

• Name of medication

• Medication expired?

  Yes

  No

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• Staff administering medication is using correct dosage

  Yes

  No

• Medication is being given to the correct child?

  Yes

  No

• Full name and signature of witness

  Sign

• Witness and Staff administered must be different

Details of medication administered

• Dosage administered (e.g. 1/2 of a 10mg tablet OR 4 puffs of Ventolin inhaler)

• Date and time of administration

  Date

• Method of administration

  Select Oral Eye drops Ear drops Inhaler Topical Injection Other

  • Oral
  • Eye drops
  • Ear drops
  • Inhaler
  • Topical
  • Injection
  • Other

• Please specify

• Date and time of last administration

  Date

• Date and time to be administered, or circumstances under which, the medication should be next administered)

• Full name and signature of staff adminstering the medication

  Sign

• Witness and Staff administering must be different

• Full name and signature of parent

  Sign