School Allergy Serious Incident and Near-Miss Record

Use the school's incident-record reference, if one has been assigned.

Enter the date on which the event occurred.

Use 24-hour time where known.

Select all that apply.

State where the event occurred, such as classroom, dining area, playground, trip or transport.

Describe what was happening immediately before and during the event.

Include anyone who experienced symptoms or was directly exposed in the event.

For each affected person, record the name or school identifier, year group or role, and whether the person was a pupil, staff member, visitor or another person. Use the school's approved record-keeping arrangements.

Record the allergen or suspected allergen. If unknown, say so and describe what was known at the time.

Record the signs and symptoms observed, including their onset and progression where known.

Give a chronological account of the actions taken, including who responded, medication or first aid provided, and when actions occurred.

Select all that apply.

Select the applicable response.

Record the person's condition at the end of the school's response and any onward care or transfer.

Record who was notified, when, and by whom, including parent, carer, emergency contact or relevant school personnel where applicable.

Select all factors that may have contributed. Do not select a factor unless it is supported by the information available.

Record actions taken to make the situation safe, preserve relevant information and reduce the chance of recurrence while the review is ongoing.

Describe records or items retained for review, such as menus, ingredient information, seating plans, statements or medication records. Do not attach confidential material to this form unless permitted by the school's procedures.

Record what the school has learned from this incident or near miss, including what worked well and what needs to change.

List each action, the person or role responsible, the target completion date and how completion will be checked.

Enter the date when completion of follow-up actions will be reviewed.

Select yes only when all actions recorded above have been completed and checked.

Record the person's name and school role.

Enter the date of the latest completion or review.

Tick if further escalation or review is required under the school's procedures.

• Tick when complete

Record any relevant information not captured elsewhere.