Your Home Number: Social Security Number: Date of Accident: Time of Accident: In your own words, describe what happened: What physical problems are you experiencing as a result of this injury? Did you report this injury to a school If not, why not? employee? Date Reported: Employee’s Name: What were you at the time of the accident? Were there any witnesses? If yes, who? Did you go to the hospital/clinic? Address of hospital/clinic: Name of treating physician: Additional comments: Date: Signature: APPENDIX B MEDICATION GUIDELINES 1. The parent/guardian should administer the initial dose and observe the student for about 20 minutes. 2. Written permission from the physician or dentist should accompany all medication to be administered. Over the counter drugs such as Tylenol, Midol, cough syrup, cough drops, inhalers, etc. may be self-administered through the office if the parents/guardian provide the medication. The permission form must be signed by the parent/guardian. The school administrator has the authority to deny the use of over-the-counter drugs. The letter/note from the parent must be kept on file until the end of the school year. Aspirin based medication is not recommended for students under 18 years of age. 3. The physician/parent permission form should be and should identify the medication, dosage, reason for the medication, time of day to be given, and anticipated number of days to be provided.
Your Home Number: Social Security Number: Date of Accident: Time of Accident: In your own words, describe what happened: What physical problems are you experiencing as a result of this injury? Did you report this injury to a school employee? If not, why not? Date Reported: Employee’s Name: What were you at the time of the accident? Were there any witnesses? If yes, who? Did you go to the hospital/clinic? Address of hospital/clinic: Name of treating physician: Additional comments: Date: Signature: APPENDIX B MEDICATION GUIDELINES 1. The parent/guardian should administer the initial dose and observe the student for about 20 minutes. 2. Written permission from the physician or dentist should accompany all medication to be administered. Over the counter drugs such as Tylenol, Midol, cough syrup, cough drops, inhalers, etc. may be self-administered through the office if the parents/guardian provide the medication. The permission form must be signed by the parent/guardian. The school administrator has the authority to deny the use of over-the-counter drugs. The letter/note from the parent must be kept on file until the end of the school year. Aspirin based medication is not recommended for students under 18 years of age. 3. The physician/parent permission form should be and should identify the medication, dosage, reason for the medication, time of day to be given, and anticipated number of days to be provided.
17-18%20Combined%20Handbook.docx