School Health Services

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Certifications

• RN License Expires

• Select date

  Date

• Vision/Hearing Expires

• Select date

  Date

• CPR or CPR Instructor Expires

• Select date

  Date

• Scoliosis completed

• Select date

  Date

Emergency Health Records

• Easily Accessible?

  Yes

  No

  N/A

• Follow up with corrected action will be completed by:

  1Day

  10 School Days

  30 Days

• Confidentiality Maintained?

  Yes

  No

  N/A

• Follow up with corrected action will be completed by:

  1Day

  10 School Days

  30 Days

Individualized Health Plans

• IHP's Written?

  Yes

  No

  N/A

• Follow up with corrected action will be completed by:

  1Day

  10 School Days

  30 Days

• IHP include evidence of outcomes progress and goals being met (either in office visits or on IHP)?

  Yes

  No

  N/A

• Follow up with corrected action will be completed by:

  1Day

  10 School Days

  30 Days

• Notification of Need to Know persons has been documented (nutrition, transportation, 504, teachers)

  Yes

  No

  N/A

• Follow up with corrected action will be completed by:

  1Day

  10 School Days

  30 Days

Student Health Records

• Confidentiality Maintained?

  Yes

  No

  N/A

• Follow up with corrected action will be completed by:

  1Day

  10 School Days

  30 Days

• Office Visit Documentation

  Yes

  No

  N/A

• Complaint

• Assessment

• Intervention

• Evalution

• Disposition

• Skyward has been updated to reflect Critical Alert if appropriate?

  Yes

  No

  N/A

• Follow up with corrected action will be completed by:

  1Day

  10 School Days

  30 Days

Medications

• Which student identifier is utilized?

  Picture on Med Bottle

  Picture on Med Form

• Signatures on Med Permission Forms?

  Yes

  No

  N/A

• Follow up with corrected action will be completed by:

  1Day

  10 School Days

  30 Days

• Principal Designee for Medication Administration Signed and in Front of Med Book?

  Yes

  No

  N/A

• Follow up with corrected action will be completed by:

  1Day

  10 School Days

  30 Days

• Medication Checklist complete for each Designee?

  Yes

  No

  N/A

• Follow up with corrected action will be completed by:

  1Day

  10 School Days

  30 Days

• Medication Counts complete for Controlled Substances?

  Yes

  No

  N/A

• Follow up with corrected action will be completed by:

  1Day

  10 School Days

  30 Days

• Medication Permission Form and Medication Bottle Match?

  Yes

  No

  N/A

• Follow up with corrected action will be completed by:

  1Day

  10 School Days

  30 Days

• Medication Bottle Properly Labeled?

  Yes

  No

  N/A

• Follow up with corrected action will be completed by:

  1Day

  10 School Days

  30 Days

• Are Epi-Pens kept in unlocked cabinet during school hours?

  Yes

  No

  N/A

• Follow up with corrected action will be completed by:

  1Day

  10 School Days

  30 Days

Diabetes

• Principal Designee: UDCA Signed and in Front of Diabetic Folder(s)?

  Yes

  No

  N/A

• Follow up with corrected action will be completed by:

  1Day

  10 School Days

  30 Days

• UDCA Checklist complete for each Designee?

  Yes

  No

  N/A

• Follow up with corrected action will be completed by:

  1Day

  10 School Days

  30 Days

Special Procedures

• Orders for Special procedures are current, signed by parent and physician?

  Yes

  No

  N/A

• Follow up with corrected action will be completed by:

  1Day

  10 School Days

  30 Days

• Principal Designee: Special Procedures Signed and easily accessible?

  Yes

  No

  N/A

• Follow up with corrected action will be completed by:

  1Day

  10 School Days

  30 Days

• Special procedures Checklist complete for each Designee?

  Yes

  No

  N/A

• Follow up with corrected action will be completed by:

  1Day

  10 School Days

  30 Days

State Required Screenings

• Vision/Hearing/AN Scheduled

• Select date

  Date

• New to District complete?

  Yes

  No

  N/A

• Follow up with corrected action will be completed by:

  1Day

  10 School Days

  30 Days

• Screening Referrals in a Timely Manner?

  Yes

  No

  N/A

• Follow up with corrected action will be completed by:

  1Day

  10 School Days

  30 Days

Atmosphere

• Clinic Neat and Organized?

  Yes

  No

  N/A

• Follow up with corrected action will be completed by:

  1Day

  10 School Days

  30 Days

• Is the Clinic Clean?

  Yes

  No

  N/A

• Follow up with corrected action will be completed by:

  1Day

  10 School Days

  30 Days

• Age Appropriate Decorations?

  Yes

  No

  N/A

• Follow up with corrected action will be completed by:

  1Day

  10 School Days

  30 Days

• Cabinets Organized?

  Yes

  No

  N/A

• Follow up with corrected action will be completed by:

  1Day

  10 School Days

  30 Days

• Cabinets Properly Labeled?

  Yes

  No

  N/A

• Follow up with corrected action will be completed by:

  1Day

  10 School Days

  30 Days

Manuals

• Substitute Folder Up To Date?

  Yes

  No

  N/A

• Follow up with corrected action will be completed by:

  1Day

  10 School Days

  30 Days

Immunization Compliance

• Immunizations Current?

  Yes

  No

  N/A

• Follow up with corrected action will be completed by:

  1Day

  10 School Days

  30 Days

• Immunizations entered into Skyward?

  Yes

  No

  N/A

• Follow up with corrected action will be completed by:

  1Day

  10 School Days

  30 Days

AED

• AED Daily and Monthly Checks are Done?

  Yes

  No

  N/A

• Follow up with corrected action will be completed by:

  1Day

  10 School Days

  30 Days

• AED Team has been identified?

  Yes

  No

  N/A

• Follow up with corrected action will be completed by:

  1Day

  10 School Days

  30 Days

• AED Team training/drills planned or held?

  Yes

  No

  N/A

• Was an after action plan completed?

  Yes

  No

  N/A

• Follow up with corrected action will be completed by:

  1Day

  10 School Days

  30 Days

Emergency Bags

• ER bag is intact, readily accessible?

  Yes

  No

  N/A

• Follow up with corrected action will be completed by:

  1Day

  10 School Days

  30 Days

Health Teaching

• Growth and Development

  Yes

  No

  N/A

• Select date

  Date

• Hand Washing

  Yes

  No

  N/A

• Select date

  Date

Flex Hours

• Are staff development hours complete?

  Yes

  No

  N/A

• Follow up with corrected action will be completed by:

  1Day

  10 School Days

  30 Days

• Special Event Committee Involvement?

• Bulletin Boards

  Yes

  No

  N/A

• Staff News Letters

  Yes

  No

  N/A

• Nurse Signature

  Sign

• Director of Health Services

  Sign