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T

W

T

F

Illness Return to Class Home Home with Temp > 100 Health Appraisals Sent First Aid Indoor Return to Class Indoor EMS/Hospital/MD Outside Return to Class Outside EMS/Hospital/MD ECP Yellow Folder DEC3 IEP/504 Meeting/Participation Hygiene Sanitary Pads Change Clothes Counseling Asthma 1. Increased Knowledge 2. Return Demonstration 3. List > 2 Triggers 4. Acceptable Peak/O2 Sat 5. Increased PE/Activity Diabetes 1. Increased Knowledge 2. WNL BS >90% 3. Correctly Counts Carbs 4. Improved Skill BS Testing 5. Calculate & Admin Insulin Severe Allergies 1. Increased Knowledge 2. Improved Skill EPI 3. Reduced Episodes 4. Recognize Hidden Triggers Weight Management 1. Increased Knowledge 2. Food Diary >30 Days 3. Increased PE/Activity 4. Correctly Count Calories Psychosocial Referrals Obtained Care Screenings Dental Referrals Obtained Care Hearing Referrals Obtained Care

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

0 0

0 0

0 0

0 0

0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0


Height/Weight/BMI Referrals Obtained Care Vision Referrals Obtained Care Lice Occurrence Scoliosis Referrals Obtained Care Education/Classes Taught Handwashing/Germs Sneeze/Cough/Nose Etiquette Growing Up Sun Safety Nutrition Dental Lice Physical Activity Prevent Smoking BLS/First Aid/AED OVERALL TOTALS STUDENT ABSENCES Number Absent Percent Absent Sent Home Sick Total Number Absent Total Absent Percent EMPLOYEE WELLNESS Staff Care Illness/Injury Chronic Acute Referrals Obtained Care Health Promotions Newsletters Speakers Classes Handouts Screenings Education Challenges Bulletin Boards Presentations

Pre-Existing Conditions

0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0 #VALUE!

0 0 0 0

0 0 0 0

#DIV/0!

#DIV/0!

#DIV/0!

#DIV/0!

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0


Weekly Totals

Running Totals

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0

0 0 0

0 0

0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

Notes


0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0

WK AVER 0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0


Health Room Yearly Log