Has someone been designated to check the Adrenaline Autoinjector expiry dates Yes No on a regular basis? Who? …………………………………………………………………………………………… Are Adrenaline Autoinjectors which are currently in the possession of the Yes No School and which have expired? Has the School signed up to EpiClub or (optional free reminder Yes No services)? Do all School Staff know where the Adrenaline Autoinjectors and the Individual Yes No Anaphylaxis Management Plans are stored? Has the School purchased Adrenaline Autoinjector(s) for General Use, and have Yes No they been placed in the School’s first aid kit(s)? are these first aid kits located? Is the Adrenaline Autoinjector for General Use clearly labelled as the Use’ Yes No ‘General Adrenaline Autoinjector? Is there a register for signing Adrenaline Autoinjectors in and out when taken for Yes No excursions, camps etc? SECTION 3: Prevention Strategies Have you done a risk assessment to identify potential accidental exposure to Yes No allergens for all students who have been diagnosed as being at risk of anaphylaxis? Have you implemented any of the prevention strategies in the Anaphylaxis Yes No Guidelines? If not record why? Have all School Staff who conduct classes with students with a medical condition Yes No that relates to allergy and the potential for anaphylactic reaction successfully completed an Anaphylaxis Management Training Course in the three years prior and participated in a twice yearly briefing? Are there always sufficient School Staff members on yard duty who have Yes No successfully completed an Anaphylaxis Management Training Course in the three years prior? SECTION 4: School Management and Emergency Response Does the School have procedures for emergency responses to anaphylactic Yes No reactions? Are they clearly documented and communicated to all staff? Do School Staff know when their training needs to be renewed? Yes No Have you developed Emergency Response Procedures for when an allergic Yes No reaction occurs? In the class room? Yes No In the school yard? Yes No
Has someone been designated to check the Adrenaline Autoinjector expiry dates on a regular basis? Who? …………………………………………………………………………………………… Yes No Are Adrenaline Autoinjectors which are currently in the possession of the School and which have expired? Yes No Has the School signed up to EpiClub or (optional free reminder services)? Yes No Do all School Staff know where the Adrenaline Autoinjectors and the Individual Anaphylaxis Management Plans are stored? Yes No Has the School purchased Adrenaline Autoinjector(s) for General Use, and have they been placed in the School’s first aid kit(s)? Yes No are these first aid kits located? Is the Adrenaline Autoinjector for General Use clearly labelled as the ‘General Use’ Adrenaline Autoinjector? Yes No Is there a register for signing Adrenaline Autoinjectors in and out when taken for excursions, camps etc? Yes No SECTION 3: Prevention Strategies Have you done a risk assessment to identify potential accidental exposure to allergens for all students who have been diagnosed as being at risk of anaphylaxis? Yes No Have you implemented any of the prevention strategies in the Anaphylaxis Guidelines? If not record why? Yes No Have all School Staff who conduct classes with students with a medical condition that relates to allergy and the potential for anaphylactic reaction successfully completed an Anaphylaxis Management Training Course in the three years prior and participated in a twice yearly briefing? Yes No Are there always sufficient School Staff members on yard duty who have successfully completed an Anaphylaxis Management Training Course in the three years prior? Yes No SECTION 4: School Management and Emergency Response Does the School have procedures for emergency responses to anaphylactic reactions? Are they clearly documented and communicated to all staff? Yes No Do School Staff know when their training needs to be renewed? Yes No Have you developed Emergency Response Procedures for when an allergic reaction occurs? Yes No In the class room? Yes No In the school yard? Yes No
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