School Allergy Individual Healthcare Plan

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

Use the date recorded in the school’s pupil records.

Enter the pupil’s current year group, form or class.

Enter the name of the school using this plan.

Enter the date from which these arrangements are intended to apply.

State the allergy or suspected allergy as recorded in the pupil’s available medical information. Do not infer a diagnosis.

Select all categories that apply. Add specific details in the next field.

List the known allergen or trigger, including relevant foods, ingredients, medicines, materials or circumstances. Record uncertainty clearly where applicable.

Describe known reaction history supplied by the parent, carer or healthcare professional, including severity and any known pattern. Do not add unverified clinical conclusions.

Record the pupil-specific symptoms or signs that may indicate an allergic reaction, using information supplied by a healthcare professional where available.

Record the pupil-specific signs requiring emergency action, as advised by the healthcare professional or stated in the prescribed emergency plan.

Record the ordered actions to take if a reaction is suspected, including when to call emergency services and when to administer prescribed medication. Follow the pupil’s clinical instructions and local emergency procedures.

Record the key information staff should provide, such as the suspected allergen, symptoms, medication given and location of the pupil.

Enter the name and formulation of each prescribed emergency medicine, including any adrenaline auto-injector brand where relevant.

Copy the prescribed dose and administration instructions exactly from the current label, prescription or healthcare professional’s plan.

Record every agreed location where the medication is stored or carried during the school day and activities.

Enter the earliest expiry date for the emergency medication recorded in this plan.

Enter the number currently available to the school, if adrenaline auto-injectors are prescribed. Enter 0 if none are prescribed.

Record practical measures for lessons, food provision, cleaning, activities, travel, events and other relevant settings. Include arrangements specific to this pupil.

Select all that apply and describe the arrangements in the next field.

Describe the controls, supervision, medication access and communication arrangements for the selected activities or settings.

List roles and names of staff responsible for day-to-day implementation, medication access and emergency response. Include a deputy or alternative where appropriate.

Record which staff groups need to know about this plan, how they will be briefed, and any relevant training or competency arrangements. Record dates separately if required by local procedures.

Record how and when information about the plan, medication, incidents and changes will be communicated, including the agreed emergency contacts.

Enter the primary contact for plan-related communication.

Enter the current telephone number, email address or other agreed contact details.

Record when this plan must be reviewed sooner than the planned review date, such as a reaction, near miss, change in diagnosis, medication, school arrangements or healthcare advice.

Enter the date agreed for review of this plan.

Enter the role and name of the person coordinating this plan and its review.

Select this only after checking the recorded allergy, emergency medication and response instructions against the current information available to the school.

• Tick when complete

Select this only after recording how the plan will be made available to relevant staff and communicated to the parent or carer, subject to applicable confidentiality requirements.

• Tick when complete