School Allergy Individual Healthcare Plan

Enter the name used in the school's records.

Use the date recorded in the school's records.

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

Use the school's internal reference if one is used.

Enter the date from which this plan is intended to apply.

Use the school's document-control convention if applicable.

Select every category that applies. Record the specific allergen or trigger below.

List the known allergen or trigger and any relevant form, source or cross-contact information.

Summarise known previous reactions and circumstances, if relevant to the arrangements in this plan. Do not use this field to replace clinical advice.

Record the signs and symptoms that staff should recognise, using the pupil's medical advice where available.

Select yes only where the pupil has prescribed emergency medication that the school is expected to hold or support the pupil to access.

If emergency medication is required, record the medication name, strength, prescribed dose, number of devices or doses, expiry arrangements and any storage or access instructions. If not applicable, enter “Not applicable”.

State the agreed locations and how staff can access the medication promptly during the school day and relevant activities.

Enter the next date by which the school should check the medication expiry or replacement arrangement.

Describe the practical steps needed to reduce the risk of exposure in lessons, meals, break times, clubs, trips, transport and other relevant activities.

Record what the pupil can do independently and what support or supervision is required. Include any age- or development-related considerations.

Record the agreed step-by-step response to suspected exposure or an allergic reaction, based on the pupil's prescribed instructions and relevant medical advice.

Record when staff should call emergency services, what information should be provided and what ongoing support or observation is required. Follow emergency-service and prescribed clinical instructions.

Record arrangements for contacting parents or carers, recording the incident, informing relevant staff and reviewing this plan where necessary.

Record the staff member responsible for coordinating this plan and ensuring relevant staff know where to find it.

List the staff groups or named staff who need information about this plan, including arrangements for cover, trips, clubs or other activities where relevant.

Describe how relevant information will be shared with staff, the pupil, parents or carers and activity or trip leaders while maintaining appropriate confidentiality.

Record any additional arrangements needed outside the usual school setting. If none are identified, enter “None identified”.

Select all that apply and add other triggers if needed.

Set a date for review appropriate to the pupil's circumstances and the school's arrangements.

Record outstanding actions, requested advice, changes made or matters to revisit at the next review.

Record the contact route that should be used for allergy-related communication, in line with the school's records and procedures.

Record the current status of discussion with the pupil and parent or carer. This is a record of the plan process, not a clinical consent statement.

Tick this box only when the recorded arrangements have been checked by the person responsible for completing or reviewing the plan.

• Tick when complete