Pupil allergy Individual Healthcare Plan

Enter the pupil's legal or commonly used full name.

Enter the date of birth in day, month and year format.

Enter the name of the school responsible for implementing this plan.

Record the pupil's current year group, class or teaching group.

Select all that apply. Select other if the reason is not listed.

Enter the date on which this version of the plan was prepared.

Set a date for reviewing this plan, and review it sooner if the pupil's needs, treatment or school arrangements change.

Describe the allergy and record whether it has been diagnosed, is suspected or is under clinical investigation. Do not use this field as a substitute for clinical advice.

Select all that apply and use the other option for any trigger not listed.

List the specific substances, products, situations or exposures that may cause a reaction.

Select all routes that are relevant to this pupil.

Record the specific measures the school will use to reduce the risk of exposure, including relevant arrangements for lessons, food, trips, clubs, transport and social activities.

Record what the pupil can recognise, avoid, carry, report or do independently, taking account of age, understanding and individual capability.

Select all that apply. Include only arrangements relevant to this pupil.

Record the symptoms that may indicate an allergic reaction for this pupil and the action staff should take. Use current clinical advice.

Record the pupil-specific signs that require the emergency response. Include any symptoms or combination of symptoms identified in current clinical advice.

Record the agreed sequence of actions, including who should provide immediate assistance, when emergency services should be contacted, and how the pupil will be supervised. Follow current clinical advice and the school's emergency procedures.

Record the number staff should use in an emergency.

Select all that apply. If medication is not relevant, select no medication required.

Record the medication name, prescribed dose, circumstances for use, number of devices or doses available, storage arrangements and any pupil-specific instructions. Use the prescription label and current clinical advice.

Record where medication is kept, how it is accessed promptly, and how arrangements apply during lessons, trips, clubs and other activities where relevant.

Record the date on which the availability, storage and expiry information for relevant medication was last checked.

List the roles and named staff responsible for implementing, communicating and reviewing this plan, including who will respond during the school day and relevant activities.

List the staff groups or named staff who need information or training to implement this plan, including staff involved in relevant activities.

Select all that apply and use the other option for any additional group. Share only information needed to implement this plan.

Record how relevant information will be communicated, when it will be updated, and how temporary or activity-specific staff will be informed.

Record where staff should document an allergic reaction, medication use, exposure or near miss, and how the plan will be reviewed after an incident.

Record the contact details that the school is authorised to use for this plan.

Where applicable, record the relevant clinician, service or current written clinical advice used to inform this plan.

Record any other information needed to implement this individual plan safely.

Select this only after the plan has been reviewed by the responsible school staff and amended where necessary. If medication or clinical advice has changed, update the relevant sections before confirming.

• Tick when complete