Medication

  • Are there 2 sets of keys for the clinic medication cabinets and to the clinic doors? Second set of keys are retained at the campus at all times.

  • Principal Medication Designation form complete for the current year.

  • Medication keys and medication cabinets are secured at the time of the audit (visual inspection).

Inventory of Controlled Medications

  • Are controlled medications properly secured?

  • Has an inventory sheet been implemented and performed weekly for each controlled medication on file in the clinic.

  • Perform an inventory review on 1 medication

  • Medication sills checklist are complete for all staff assigned to administer medication

  • Current clinic standing orders are visible in the front of medication binder.

  • Medication Opt Out list is visible for UAP and RN Substitutes.

Health Conditions/Health Information

  • Have student health histories been reviewed and entered in Skyward?

  • Alerts/critical alerts have been entered and updated in Skyward.

  • Notification of need to know staff has been completed? (Student Nutrition, Teachers, Campus 504 Coordinator, Transportation)

  • EMS envelopes for identified students are readily available for student health emergency (Include Emergency Care Form, Student Health History, Physician Orders, Action Plans, etc.)

  • Emergency Guidelines for School Staff binder readily available to school staff who assist in the clinic.

Anaphylaxis/Allergy

  • Has staff allergy/anaphylaxis training been completed and documented? (Enter details of training in text box)

  • Epinephrine auto-injectors are kept in an unlocked cabinet during the school day.

  • Epinephrine auto-injectors are clearly labeled to allow for rapid identification.

Diabetes Care

  • UDCA Principal Assignment Form is signed (annually).

  • All assigned UDCAs have completed initial training (current or previous year).

  • Individualized training completed and documented on appropriate skills checklists (review/return demonstration)

  • Diabetes Management and Treatment Plan is current, signed by parent and physician.

  • Emergency Action Plan (EAP) has been completed for quick reference by the teachers and staff.

  • Diabetes emergency kits in place in classrooms/specials areas in the event of a lockdown or students carry their own emergency supplies.

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

Special Procedures

  • Orders for special procedures(s) are current, signed by parent and physician. (Enter procedures in text box below)

  • Initial/Baseline physical assessment has been completed for all students with special procedures/medically fragile.

  • UAP/staff members are trained to perform the special procedure.

  • Initial and a minimum of 3 return demonstrations have been documented in Skyward or on appropriate skills checklist.

  • RN supervisory visits are performed regularly and documented (assessment of student + supervision of UAP).

Individual Health Plans

  • IHPs have been created or updated for: Medically complex, medically fragile, require routine/scheduled nursing services.

  • IHP review: select one IHP and review along with supportive documentation (office visit notes, medication notes, physical assessment, skills training, supervision notes, action plans, physician orders, etc)

Emergency Preparedness

  • Emergency Care Forms are printed and available to be quickly accessed during an emergency.

  • Evacuation plan in place for emergency medical supplies, easy to follow, and can be rapidly completed by clinic staff or RN Substitutes.

  • Campus RN has evacuated with medical supplies with at least one evacuation drill.

  • Emergency bag is intact, unexpired, and readily accessible.

  • Plan in place for entry into locked bathroom doors in clinic or other campus locations (hex/allen key, coin, other device) and campus staff know procedure and location of device.

  • AED/MERT team members with current CPR certification has been identified.

  • AED/MERT drill/training for the 1st semester has been completed (Note date). Notify Health Services Coordinator of date when 2nd semester drill completed.

  • AED daily and monthly checks completed and documented.

  • AED annual check is completed.

  • Documented evacuation chair training on file for 2 story campuses.

Substitutes and Substitute RN Binder

  • Guidelines for the School RN visible/readily available.

  • Does campus sub coordinator have current list/contact information of sub RNs?

Sub Binder/Information

  • Current student health condition information is readily available in the purple binder.

  • Emergency procedures explained and easy to follow.

  • Clinic Information/Welcome sheet is current.

  • Campus specific information is easily located- Schedule of the day, Specials rotations, Teacher list with phone numbers, etc)

  • Location of special procedures, medications, diabetes supplies are clearly marked. Directions for special procedures are explained and easy to follow.

Comprehensive School Health Program

  • Nurse is wearing name badge.

  • Professional Development hours completed with content relevant to nursing.

  • LVN or clinic assistant is receiving appropriate supervision by RN (documented).

  • Bloodborne Pathogens course completion by campus staff is documented

  • Vision and hearing screening complete and entered in Skyward.

  • AN screening complete and entered in Skyward.

  • Have AN results been entered in RFES for state.

  • Spinal screening complete and entered into Skyward.

Classroom/student education done according to health TEKS and/or campus-student health needs.

  • 5th Grade Boys and girls Growth and Development presentation completed.

  • Assisting with the Sexual Health and Wellness Curriculum for 6th, 7th, and 9th graders.

  • Hand washing, respiratory etiquette, cold & flu prevention

  • Dental education for 1st grade, and may include other grades.

  • Reminders/campus-wide information for hand washing, respiratory etiquette, cold/flu prevention.

  • Other (list)

  • Monthly biological calibration of audiometer is documented.

  • Clinic is orderly and free of clutter.

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

  • Special event/committee involvement?

  • Professional Goals for current school year:

  • Coordinator of Health Services

  • School Nurse

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. Any ratings or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.