Both forms below must be filled out and signed by a parent/guardian and a licensed healthcare provider for students that need food related accommodations for meals/snacks at school. Completed forms are to be faxed to Nutrition Services and shared with the kitchen manager at the school the student attends. These diet forms only need to be updated if a change is necessary.
Head Injury - Concussion
A concussion is caused by a bump, blow, or jolt to the head. Concussions can also occur from a fall or blow to the body that causes the head to move rapidly back and forth. Even what seems to be a mild bump to the head can be serious.
Head injuries or bumps should be monitored for signs and symptoms of a concussion. Use the Flow Chart, Checklist, Parent Notification Letter, and Signs/Symptoms Poster linked below to guide you.
Health Office Tools
The WCSD follows the guidance and recommendations provided by the Utah Department of Health and the American Academy of Pediatrics in regards to illness and communicable disease. Consult with your assigned school nurse as needed.
- Sick Day Guidelines
- Exclusion for Illness or Medical Condition - English Spanish
- Exclusion for Illness - Millcreek Nursery
- Exclusion Letter- Vaccine Preventable Outbreak
- Exposure to Communicable Disease- Parent Letter
- UDOH Guidelines for Communicable Disease
- Conditional Enrollment - Parent Letter
- Conditional Enrollment - Parent Letter - Spanish
- Exclusion for Inadequate Immunizations - Parent Letter
- Exclusion for Inadequate Immunizations Parent Letter - Spanish
- Flyers/Handouts - Immunization Requirements
- Pink Card /Utah State Immunization Record (USIR) Form
- Pink Card How To Fill Out
- Utah Immunization Guidebook 2022-23
- WCSD Immunization Policy
FOR STUDENT INJURIES:
A student injury severe enough to cause the loss of one-half day or more of school and/or warrant medical attention and treatment needs to be reported by school secretaries to the Utah Dept. of Health "Student Injury Report - Violence and Injury Program online:
- SIR website
- SIR hard copy report form
FOR STAFF INJURIES:
Coordinate with your assigned school nurse for assistance with challenging cases and re-infestations. Provide parents with instructional materials linked below. Each school may order lice treatment kits through the warehouse.
- Head Lice WCSD Administrative Letter/Policy
- Head Lice -Info for Schools - UDOH
- Head Lice - Parent Letter
- Head Lice - Parent Letter - Spanish
- UDOH Getting Rid of Head Lice Parent Handout
- UDOH Getting Rid of Head Lice Parent Handout - Spanish
- UDOH Head Lice Control Guidelines Booklet
- UDOH Head Lice Control Guidelines Booklet - Spanish
- For assistance, contact Shallen Sterner, Southwest Utah Public Health Department, Environmental Health- 435-986-2580
- WCSD Bed Bug Inspection Letter to Parent
- EPA Bed Bug Guidance for school Administrators, Teachers, and Staff
- Bed Bug Parent Fact Sheet - UDOH
- Preventing & Getting Rid of Bed Bugs Safely - UDOH Booklet for Parents and Schools
- Bed Bug Life Cycle
- Bed Bug video - Spanish
- Bed Bug Prevention/Treatment Handout- Spanish
Coordinate with your assigned school nurse, the PTA, and a male presenter to schedule a date/time for the 5th grade Maturation presentation. Boys and girls are taught separately. Schools typically prefer presentations to be in the afternoon, right before a holiday or break.
Per Utah State Board of Education (USBE), parents must receive the consent form linked below no later than two weeks prior to the beginning of instruction.
Medical forms must be filled out and signed by a parent/guardian, and a licensed healthcare provider if medication is to be administered. Click links below for forms.
Medication Authorizations (Orders)/IHP/EAP Forms - UDOH
- Allergy Emergency Plan
- Asthma Action Plan
- Diabetes Emergency Plan
- Diabetes Healthcare Plan
- DMMO (Diabetes Medication Management Order)
- Diabetes CGM (Continuous Glucose Monitor) Addendum
- Diabetes Injection (pens-syringe & vial) Addendum
- Diabetes Pump/Smart Pen Addendum
- Generic IHP/EAP
- School Medication Authorization- for general medications that do not have a medication specific form ( ex: ADHD meds, oxygen, Tylenol, G tube meds, pancreatic enzymes, etc.)
- Seizure Action Plan (IHP/EAP)
- SMMO (Seizure Medication Management Order)
Procedure Forms - WCSD
- Medication Calendar - 2022-23
- Medication Calendar - blank
- Medication Incident Report
- Medical Release Form editable or PDF spanish editable spanish PDF
- Medical Release to Return to School After Surgery
- Medical History English - Spanish
- Parent Permission Only- Student Medication Self-Administration (6 -12th grade only)
WCSD Medication Policy
The WCSD school nurses perform spinal/scoliosis screenings at the request of a parent/guardian. The Utah Department of Health recommends against mass routine school scoliosis screening. The Spinal Research Society recommends that girls be screened twice at ages 10 and 12 (5th & 7th grade), and boys be screened once at either age 13 or 14 (8th or 9th grade).
Coordinate with your assigned school nurse to determine when to send home the Parent Scoliosis Letter and Instructional Handout.
Standards of Care
Listed below are the Utah Department Health (UDOH) general standards of care for students with medical concerns. The student’s health care provider may indicate exceptions to these standards on the student’s individual medication authorization (order)/IHP/EAP forms. The school nurse ultimately determines if the authorization/order is safe and appropriate to delegate to unlicensed school staff.
The Medical Director for the WCSD has written orders for a variety of Over The Counter (OTC) products that can be used by trained staff to treat students. School staff must obtain parent/guardian permission each time a Standing Order OTC product is administered, unless the student has a specific medication authorization form (order) completed and signed by a parent/guardian and their healthcare provider. Documentation of each medication administration in the student's personal educational record is required.
Additionally, the WCSD Medical Director has written Standing Orders for emergency use of stock Epi-Pen (for severe allergic reaction) and naloxone (for opioid over-dose) that can be administered by trained staff to any student, staff, and visitors. These emergency medications are to be administered as per the Standing Orders, then emergency services and parent/guardian are to be contacted. If a student has a specific medication authorization for Epi-Pen or naloxone, follow the student's specific medication authorization form (order) completed and signed by a parent/guardian and their healthcare provider.
For quick reference, print the Standing Orders below and keep accessible.
The Utah Department of Health (UDOH) requires Tier 1 screening of students for distance visual acuity for pre-kindergarten, kindergarten, and grades 1, 3, 5, 7 or 8, and 9 or 10. Tenth grade students may be screened as part of their driver education class. Students referred by a parent or school personnel should also be screened during any grade. Students in the grades listed above must be screened annually.
Tier 2 vision screening is a higher-level evaluation which should include screening of distance (if not done in the current year) and near vision. Optional screening includes eye focusing or tracking problems, and convergence insufficiency. Tier 2 vision screening can be classified as mandatory (students needing educational intervention, special education referral, or failing benchmark assessment) or optional (teacher or parent concern).
For financial assistance for a professional eye exam and if needed, glasses, contact your assigned school nurse or the WCSD Support Services Coordinator/ Homeless Liaison.