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 Health Forms

Accident Incident Report Form.pdfAccident Incident Report FormStudent & Non-employee accident/incident report form
ImmunizationRecord.pdfImmunizationRecordMN Dept. of Health immunization record
StudentEmergencyContactInformation.pdfStudentEmergencyContactInformationAnnual verification form of student and emergency contact information – health information
Asthma Emergency Care Plan.pdfAsthma Emergency Care PlanAsthma emergency care plan form
DiabetesEmergencyCarePlan.pdfDiabetesEmergencyCarePlanDiabetes emergency care plan form
SeizureActionPlan.pdfSeizureActionPlanSeizure Action Plan Form
Severe Allergy Emergency Care Plan.pdfSevere Allergy Emergency Care PlanSevere Allergy Anaphylaxis Action Plan Form
MedicationFormK-5.pdfMedicationFormK-5Authorization to administer medication at school for students in grades K-5
MedicationForm6-12.pdfMedicationForm6-12Authorization to administer medication at school for students in grades 6-12
SelfAdminister_EmergencyEpinephrine–PhysicianandParent.pdfSelfAdminister_EmergencyEpinephrine–PhysicianandParentAuthorization for self administration of emergency epinephrine to be completed by physician and parent
SelfAdminister_EmergencyEpinephrine–Student.pdfSelfAdminister_EmergencyEpinephrine–StudentAuthorization for self administration of emergency epinephrine to be completed by the student and licensed school nurse
SelfAdministerInhaler-PhysicianParent.pdfSelfAdministerInhaler-PhysicianParentAuthorization for self-administration of inhaler to be completed by physician and parent
SelfAdministerInhaler–Student.pdfSelfAdministerInhaler–StudentAuthorization for self administration of inhaler to be completed by the student and licensed school nurse

 District Policies

420Students and Employees-Communicable and Infectious Diseases
Students and staff of the District should be able to attend the schools of the District without becoming infected with a serious communicable or infectious disease including but not limited to, Human Immunodeficiency Virus (HIV), Acquired Immunodeficiency Syndrome (AIDS), Hepatitis B, and Tuberculosis. Measures that effectively respond to health concerns while respecting the rights of all students, employees, and contractors, including those who are infected, need to be adopted by the School Board. The purpose of this policy is to adopt such measures.
516Student Medication
The purpose of this policy is to set forth the provisions that must be followed when administering both prescription and nonprescription medication during the school day. 
530Immunization Requirements
The School Board is committed to providing a safe and healthy environment. The purpose of this policy is to ensure that parents and students are aware of the State of Minnesota’s requirement for immunizations and that all students receive the proper immunizations as mandated by law.
545Health Service Program
The fundamental purpose of the School Health Service Program is to aid parents/guardians in protecting, improving and maintaining the health of their students. While parents/guardians have the primary and ultimate responsibility for their student’s health, the School Health Service Program will assist parents/guardians in fulfilling their responsibility, and to assist students in developing competence to deal with the health issues they will face during their school years and in the future. The District is responsible for developing objectives and procedures to ensure the accomplishment of the School Health Service Program.
     
   
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