• 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.


  • 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

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