Section 504 Plan Outline

Posted by on Sep 15, 2012 in Articles, Testimonials | 0 comments

SECTION 504 PLAN OUTLINE

ARTICLE OVERVIEW

This 504 Plan Outline is divided into PARTS A-O, and within each part there are sub-topics. To create this outline, I collected 504 Plans for children with severe food allergy from around the country. I also researched the format of 504 Plans for children with other disabilities who are protected under Section 504. I extrapolated the questions parents and 504 Team members asked themselves when they created the 504 Plans.

This outline is not intended as professional advice, and these questions are simply the ones I will ask myself while crafting my own child’s 504 Plan as part of a 504 Team. I am not a doctor, and this outline is intended as a parental resource only. Please be aware that no 504 Plan can ensure the safety of your child, and only you, your physician and your school district can work together to create a 504 Plan that is appropriate for your child. This outline is not intended to replace the medical advice, prescriptions or treatments prescribed by your doctor. Lastly, be aware that only you and your physician can determine the trade off between “physical safety and social normalcy” (Lisa Cipriano Collins).

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SECTION 504 PLAN OUTLINE

FOR CHIDREN WITH SEVERE FOOD ALLERGIES

TABLE OF CONTENTS

Part A Student Information
Part B 504 Team Members and Meeting Information
Part C Background Information
Part D Overview of Child’s Condition as it Pertains to Section 504
Part E Goals of the 504 Plan
Part F Food Allergy Education, Awareness & Reaction Prevention
Part G Individualized Health Care Plan (IHP)

  • Emergency Health Care Plan (EHP)
  • Severe Food Allergy Alert Flyer & Emergency Instructions
  • Medicine Pack Content List and Location
  • Training Documentation
  • Student Level of Self-Care Assessment Data Sheet
  • Parental Notification of all Allergic Reactions
  • Brief Medical History
Part H Classroom Management
Part I Instructional Aids
Part J Substitute Teachers and Nurses
Part K Bus Transportation
Part L Signature Page
Part M Copy of Section 504 of the Rehabilitation Act of 1973 & Copy of Statement of Parental Rights under Section 504
Part N Cover Letter
Part O Additional Resources

PART A: STUDENT INFORMATION

  1. What is some important information that the school needs to track this document and file it?
  2. For which school building is the plan written?
  3. What are the important meeting dates?

Format Examples:

  • Name of the Student
  • Name of Student’s Parents
  • Date of Birth of the Student
  • Grade of the Student
  • School Child Attends
  • Name of the School District
  • Date of the Current 504 Meeting
  • Date of the Next 504 Meeting

PART B: 504 TEAM INFORMATION

  1. What are the first and last names and titles of the individuals attending this 504 Meeting?

Format Examples:

  • Child’s Parents
  • Primary Classroom Teacher
  • School Nurse
  • 504 Coordinator
  • 504 Compliance Officer for the School Building
  • Director of Pupil Personnel
  • School Psychologist
  • Building Principal
  • Health Aide
  • Plan Monitor
  • Title of Other

PART C: BACKGROUND INFORMATION

  1. Will the parents provide general information about food allergy, environmental allergies, and asthma?

Format Example: Questions appear, followed by a thorough explanation.

  1. What is food allergy? (Explain.)
  2. What is anaphylaxis and its symptoms? (Explain.)
  3. What types of reactions are there? (Contact, Ingestion, Inhalation – Explain.)
  4. What is cross contamination in general? (Explain.)
  5. What are environmental allergies? Ex. dust mite, dog dander (Explain.)
  6. What is asthma? (Explain.)
  7. What additional risk does an asthmatic have during an allergic reaction? (Explain.)

PART D: OVERVIEW OF THE CHILD’S CONDITION

  1. Will the parents explain which food and environmental allergies the child has and how the child reacts to the allergen(s)?
  2. Are there other allergies or medical conditions that render the child eligible for receive protection under Section 504 that need to be included in this plan?
  3. What proof does the parent have of the child having the allergy or that the child is regarded as having the allergy?
  4. Do the parents have a letter from the child’s doctor stating the danger of anaphylaxis and the need for the child to have an EpiPen Jr. with him or her at all times?
  5. Do the parents have the formal test results from the CAP RAST and or the Prick Skin Tests?
  6. What major life activity is affected by the allergy?
  7. What documents will be part of this 504 Plan that addresses the child’s needs?

Format Examples:

  • Nature of the concern for the child:
    • The child has ingestion allergy reactions to …
    • The child has contact allergy reactions to …
    • The child has inhalation allergy reactions to …
    • The child has seasonal allergies to …
    • The child has asthma which is triggered by…
  • Basis for the determination of the disability:
    • See the physicians letter dated …
    • See the allergy testing results dated …
    • See the parent diary of allergic reaction dated from…to….
  • Disability that affects a major life activity:
    • The child’s anaphylactically allergic to ___________. This onset of the reaction can be sudden, and fatal within minutes. It must be treated immediately.

The life system of breathing is affected which makes the child eligible for Section 504.

Necessary Accommodations and Modifications will be addressed in all of the subsections of this 504 Plan

PART E: GOALS OF THE 504 PLAN

  1. Will the parents write a paragraph discussing the main goals of the 504 Plan that discusses the importance of:
    • adhering to all aspects of the 504 Plan to avoid the allergen.
    • assisting the child to maintain a stable physiological state void of allergic reactions through preventative measures.
    • recognizing the signs of an allergic reaction and treating it promptly in all school contexts.
    • striking a balance between safety and social normalcy, providing the same opportunities and conditions as the child’s peers, and offering encouragement to the child.
    • encouraging open and on-going communication among adults about food allergy issues and doing so discretely and in the appropriate forum.

PART F: FOOD ALLERGY EDUCATION, AWARENESS & REACTION PREVENTION

What kind of training needs to take place to promote education, awareness and reaction prevention in the school context?

  1. What kind of training will be offered to individuals, given the different role they play in the child’s life who has f/a?
  2. Who will receive this education, training and awareness?
  3. Who will provide this education, training and awareness?
  4. What role will the parents play in the training?
  5. How, where and when will this take place?
  6. What resources will be provided, acquired and by whom?
  7. Which school personnel will receive training depending on that individual’s role in the child’s life?

Types of Education, Awareness and Reaction Prevention

  1. Label Reading
  2. Proper Hand Washing
  3. Cross Contamination and Avoiding It
  4. Effective Table and Desk Washing with Appropriate Chemicals and Materials
  5. Knowledge of the Location of the Medicine Pack(s)
  6. Recognition of Allergic Reaction
  7. EpiPen Jr. Administration and Emergency Response
  8. Positive Role Modeling*
  9. Promotion of Positive Self-Esteem for child w/fa
  10. Promotion Peer Support for Child w/fa

Example

*Positive Role Modeling – All adults in the school context can demonstrate their support for the preventative measures specified in a child’s 504 Plan to staff members, students and parents. Teachers, especially, are significant role models in the daily lives of children. A positive role model would not make statements to parents and students such as, “We cannot have a holiday party because of Patricia and her food allergies.” A positive role model would say, “We are going to have a holiday party and we will make it fun and safe for everyone.”

Recipients of Education, Awareness and Reaction Prevention

  1. Primary classroom teacher (s)
  2. Classroom paraprofessional
  3. Unified arts teachers (specials teachers)
  4. Other teachers in the building
  5. Custodial staff
  6. Cafeteria staff and lunch proctors
  7. Other paraprofessionals in the building
  8. Support staff
  9. Secretaries
  10. Bus drivers and bus company personnel
  11. Other Students in class of child with f/a
  12. Parents of other children in the class of the child with f/a
  13. Other students in the child’s school
  14. Parents of other children in the school

PART G: INDIVIDUALIZED HEALTH CARE PLAN (IHP)

“It is the position of the National Association of School Nurses that each student with a relatively complex health condition or a need for modification of the school environment due to a health condition should have an IHP. It is also the position of NASN that the professional school nurse should be responsible for the writing of the IHP in collaboration with the student, family, and health care providers.” (Cite: National Association of School Nurses, http://www.nasn.org/positions/careplans.htm.) The IHP contains a number of components which may include but are not limited to:

EMERGENCY HEALTH CARE PLAN (EHP)

Possible Elements of the EHP; answers to be written in Statement Form

  1. What are the signs of a mild reaction?
  2. What steps should the adult in charge take in the event of a non-life threatening reaction?
  3. If the child is contact allergic, what should happen should the allergen touch his or her skin?
  4. What are the signs of a serious reaction?
  5. What are the steps that should be followed in the event of a serious reaction and medical emergency?
  6. What are the names of the individuals who are trained to administer the emergency medication?
  7. Do the parents have a chain list of individuals that can administer the emergency medication, in case the first person on the list is not available?
  8. How much medication should be administered?
  9. What steps will be taken if the child does not cooperate during the administration of the medication?
  10. Who will call 911?
  11. On what telephone will 911 be called?
  12. What telephone script will be followed when calling 911 and where will it be posted? (See sample script at www.foodallergyinitiative.com) Will the caller tell the 911-operator to bring more epinephrine?
  13. Will the child w/fa remain in the classroom or be brought to the office?
  14. Will it be stated that the child having any type of allergic reaction must not be allowed to walk to the nurse or anywhere else alone?
  15. If the child goes to the office to wait for the ambulance, what route with in the school will be taken?
  16. To what hospital will the child be transported?
  17. Who will ride in the ambulance with the child?
  18. How and when will the parents be contacted?
  19. Who will call the child’s parents?
  20. What will be said to the parents on the telephone?
  21. Will the child wear a MedicAlert bracelet?

Format Examples:

Additional Information stated in the 504 Plan

  1. The Emergency Response Protocol will be stated in this document as well as on a sheet of paper.
  2. The EHP will be kept in the following locations by the following individuals…
  3. The nurse/case manager will collaborate with the parents of the child w/fa and child’s physician to write an EHP based upon physician’s orders and directives regarding allergy (and asthma management).
  4. The plan will be reviewed with the following individuals… (principal, classroom, special area teachers)
  5. The plan will be reviewed at the following times during the year…
  6. The EHP will be updated annually and signed by …
  7. All of the child’s teachers and aides review the EHP in detail.
  8. A copy of the EHP will be retained by the child’s classroom teacher and placed…
  9. A copy of the EHP will be made available to substitute teachers by…
  10. A copy of the child’s EHP will be kept in the child’s cumulative health record.
  11. A copy of the child’s EHP will be posted at all times in the Health Office which is routinely done for all medically involved students.

SEVERE FOOD ALLERGY ALLERT FLYER AND QUICK EMERGENCY INSTRUCTIONS

  1. Will the parents create a Severe Food Allergy Alert Flyer?
  2. What important information will it include?
  3. Will the flyer be posted discretely or overtly in different areas of the school?
  4. Will the flyer be in all the teacher’s plan books?
  5. Will the flyer be in all the relevant substitute teacher folders?

Format Example:

  • Title – Fatal Food Allergy Alert
  • List of dangerous food Allergens
  • State the Child’s Name
  • Classroom Teacher
  • Parent Contact
  • Parent Page Number
  • Picture of the Child
  • Fundamental Rules of the classroom about food
  • List of the signs and symptoms of an allergic reaction
  • Action to be taken in the event of an emergency situation
  • Picture of EpiPen Jr. administration procedure

Physical Location Examples

  1. Classroom
  2. Art Room
  3. Gymnasium
  4. Library
  5. Music Room
  6. Cafeteria
  7. Custodian’s Office
  8. Bus Company Main Office
  9. All grade level classrooms of the child
  10. Principal’s office
  11. Main Office – at all secretaries’ desks
  12. Nurse’s office
  13. Staff Lounge

MEDICINE PACK CONTENTS AND LOCATION

  1. Where will the pack be at all times during the day?
  2. What medicines will be in the medicine pack?
  3. Will there be administration instructions with the medicine and their correct doses?
  4. If there is liquid antihistamine in the Medicine Pack, will there be a measuring utensil in the Medicine Pack?
  5. Who will be responsible for checking the expiration date of all the medications that are kept at the school and how will this information be documented?
  6. What if the first dose of the medicine does not seem to be working?
  7. Will copies of the child’s insurance information be in the medicine pack?
  8. Will there be extra emergency medicine in the building in case someone misplaces the Medicine Pack?
  9. Will the extra emergency medicine be locked up somewhere?
  10. Who will have the key?
  11. Will there be extra keys?

Format Examples:

  1. The Medicine Pack will contain the following medicines…
  2. The correct does of medicine will be stated…
  3. The Medicine Pack containing the EpiPen Jr. should not be exposed to extreme heat or cold…
  4. The Medicine Pack will contain copies of the student’s insurance information that states…
  5. The Medicine Pack will have instruction for the Emergency Response Protocol that states…
  6. The Medicine Pack and Emergency Response Protocol will remain with the child at all times: regular academic, specials, recess, lunch, specials assemblies, special events, fire drills, etc.
  7. The Medicine Pack will be handled by the following individuals throughout the school day…
  8. Additional emergency medicines including EpiPen Jr.s and Antihistamine that are not kept in the medicine pack will be located…
  9. Additional keys to the cabinet where the extra emergency medicines (ex. EpiPen Jr. and Antihistamine) will be located…

TRAINING DOCUMENTATION

  1. What types of forms will be completed by the school nurse and or the school medical consultant that documents which individuals have been trained to administer medications such as Epinephrine, Albuterol, and Children’s Benadryl.
  2. What types of forms will be completed by the school nurse to document who has been trained at the set up and administration of a Nebulizer?

STUDENT LEVEL OF SELF-CARE ASSESSMENT DATA SHEET

  1. Will the parents create a student self-care assessment data sheet each year that lists the child’s ability to manage his/her food allergy in school?

Format Example:

The student’s current ability to perform various food allergy self-management skills is indicated by a checkmark next to either “yes” or “no” for the following skills:

  1. The student is always able to visually recognize the allergen in all its discrete forms (ex: peanut: peanut butter, peanuts etc.) or part of another food (ex. peanut butter cookie). __________Yes _____________No
  2. The student is always able to read labels for the offending allergen. __________Yes _____________No
  3. The student is always able to recognize signs of an allergic reaction. __________Yes _____________No
  4. The student is always able to verbally communicate body discomfort associated with an allergic reaction. __________Yes _____________No
  5. The student always knows to wash his/her hands well with an approved soap and warm water before eating. __________Yes _____________No
  6. The student always knows to eat only food brought from home. __________Yes _____________No
  7. The student always knows not to trade food with classmates and adults. __________Yes _____________No
  8. The student always understands how a safe food may become cross-contaminated with an allergen. __________Yes _____________No
  9. The student is always able to discern between the allergen itself and objects or animals with the same name as the allergen: Example – the guinea pig named “Peanut Butter.” __________Yes _____________No
  10. The student is always able to keep track of his/her medicine pack while in school. __________Yes _____________No
  11. The student always knows the steps to take is she/he is having an allergic reaction. __________Yes _____________No
  12. The student has been trained in and is of an appropriate age to administer his/her own EpiPen Jr. medication. __________Yes _____________No
  13. The student has been trained in and is of an appropriate age to administer his/her own Albuterol medication. __________Yes _____________No

PARENTAL NOTIFICATION OF ALL ALLERGIC REACTIONS

  1. Will the parents request that the school nurse or any other staff member notify them any time the child receives medication of any type?
  2. What is the timeline for parental notification of medication administration?

BRIEF MEDICAL HISTORY

  1. Will the parents write a brief summary of the child’s medical history and allergic reactions?

PART H: CLASSROOM MANAGEMENT
COMMUNICATION

  1. What type of communications will occur between the principal and the parents of the child’s classmates and school? When will it be sent, how and how often?
  2. What type of communications will occur between the classroom teachers to other parents in the class and school? When will it be sent, how and how often?
  3. What type of communications will be occur between the classroom teacher to the parents of the child w/fa? When will it be sent, how and how often?
  4. What type of communications will occur between the parents of the child w/fa to other parents? When will it be sent, how and how often?
  5. What type of Communication will occur between the principal and the rest of the staff?
  6. What kind of input will parents of the child w/fa have in the content of informational materials that are disseminated to parents and school staff regarding the child’s food allergy?
  7. Will the parent be given a tray or inbox located in the office to facilitate communication among the school staff and the parent?

Format Examples:

  • Administration – Classroom Parents Communication
    • A letter will be sent home to classroom parents stating…
    • A letter will sent home the last day of school informing parents…
    • A letter will be sent home urging staff and students to…
  • Parent of Child with Allergy – Teacher Communication
    • The parents of the child with the food allergy and the classroom teacher will have a scheduled meeting ____ time(s)each month -throughout the year to discuss any issues or concerns.
    • Open and frequent home – school communication will be maintained through… (ex hand written notes, telephone, e-mail)…
    • The teacher will send home a “safe food list” created by the parents of the child with food allergy. The list will expressly state that the child is to eat only those foods provided by the parent regardless of their presence on the safe food list.
    • The teacher will communicate to parents of the child with the food allergy regarding projects involving food and…
  • Parent – Classroom Parents Communication
    • A letter will be sent to classmate’s homes written by ___________________. This letter will inform them of the child’s allergy and what the school is asking other parents in terms of food items they bring to school.
    • On going communication among all classroom parents with regard to the issue of group snacks and treats will be encouraged.

TEACHER LESSON PLANS

  1. Will the parents request that no teacher lesson plan include the offending allergen(s)?
  2. Will the parents request that no games or activities in the school environment include the allergen?

PARAPROFESSIONAL

  1. Do the parents feel the need for a paraprofessional to be provided to assist the classroom teacher?
  2. What will the focus of the paraprofessional be?

Format Examples:

  • A paraprofessional will be provided…
  • The focus will be…

LABEL READING

  1. Will appropriate school personnel be trained in reading labels for hidden allergens in food related activities?

HAND WASHING OF CHILD W/FA AND OF PEERS

  1. Will the parents request that any additional steps be taken to remove the allergen from the other students’ hands?
  2. Will the parents request that steps be taken for the child to wash his/her hands before eating?

Format Examples:

  • Upon entering the classroom, students will…
  • Before eating, the child with food allergies will…
  • Hand washing of peers before and after handling foods will be…

SOAP

  1. Will the parents allow the child to use the bar of soap or soft soap that the other children in the class or bathroom use?
  2. Will the parents provide soap, or will the school provide a particular brand of soap?

FOOD & BEVERAGE CONSUMPTION IN THE CLASSROOM

  1. What are some circumstances in the classroom involving food and beverages that might present a problem?
  2. Will the parents request that all teachers and all other staff members not distribute food as a reward, and request that non-food items be used as rewards?
  3. What steps should be taken if the allergen enters the environment beyond the acceptable safety perimeters?
  4. What will the teacher do with the snack that falls outside of acceptable safety perimeters?
  5. Will the parents provide safety snacks that will be left in the classroom?
  6. Will the parents provide enough safety snacks for the entire class?
  7. What steps will be taken to avoid cross-contamination while storing the safety snack?
  8. Will the parents create a list of acceptably safe foods to be consumed around the child?
  9. Will the parents provide all the child’s snacks from home?
  10. Who will the child sit with or near during snack time?
  11. Who will the child not be permitted to sit near or with during snack time?
  12. Will children in the classroom be encouraged or discouraged to share snacks in the classroom?
  13. Will teachers or aides (or other) wash classroom tables thoroughly before and after snack with an appropriate cleaning solution and dried them?

Format Examples:

  • The child will only consume food considered safe provided from the child’s home. No other food is to be consumed by the child under any circumstances.
  • The child will sit with his peers to eat and participate…(specify peer group and where the parents want the child to sit during snack time)
  • In the event that questionable foods are being served or brought into the classroom…the child will have access to a safe and fresh safe snack (safety snacks) which will be pre-approved by his/her parents.
  • The parents of the child w/fa will ensure that an appropriate supply of safety snacks are located in a secured area of the classroom.
  • To avoid cross-contamination, the safety snacks will be located…
  • Should students bring in an allergen containing food, it will be…(discarded) and the students will be offered…
  • A supply of safety snacks for the entire class will be made available by…
  • The parents will create and maintain a food list that states…
  • Children will be instructed on food sharing policies in the classroom that state…

WATER FOUNTAIN

  1. Will the parents allow the child to drink from any water fountain in the school building?
  2. Will the parents request that the child have access to bottled water?
  3. Who will provide the bottled water and where will it be stored?

CLEAN-UP TIMES AFTER SNACK

  1. Should the child participate in clean-up activities involving waste products, the washing of tables etc.

Format Examples:

  • Children in the class will be instructed in the importance of cleaning up after snack and recess.
  • The child will not be asked to assume or be allowed to assume any classroom tasks involving foods, waste products or washing tables, except for …

STORAGE OF CLASSROOM LUNCHES

  1. Where will the child’s lunch be stored?
  2. Where will other children’s lunches be stored?
  3. Does the child need to store his/her lunch in a secure place separate from the rest of the class?
  4. Should the child store his/her lunch with the rest of the class?
  5. Should the child have access to a dedicated “small” refrigerator in a secure area?
  6. Should the parents child have access to a microwave s/he want to heat his/her lunch in a secure area?

Format Examples:

  • Classroom lunches will be stored…
  • The child w/fa will store his/her lunch…

RECESS

  1. What are the parents concerns (if any) about food allergen residues on the playground equipment?
  2. What steps will be taken to address the possible risk of food residue being brought into the classroom from the playground equipment?

Format Example

  • The following measures will be taken to lesson the risk of food allergens being carried in from the playground equipment…

BATHROOM

  1. Will the parents request that the child have access to a bathroom in the nurses office any time of day should s/he want it?

OTHER ROOMS USED IN THE SCHOOL

  1. What steps and risk assessment should occur if the class participates in an activity that is in a different room other than the regular classroom?

Format Examples:

  • If other rooms other than the regular classroom are being used…then…
  • The child will only be sent to other classrooms and areas of the building with the classroom trained teacher or paraprofessional.

SPECIALS: ART, GYM, MUSIC & LIBRARY

  1. What are some of the possible risks presented by the following specials classes?
  2. What steps should be taken to reduce risk?

Format Examples:

  • During Art the following steps will be taken…
  • During Gym the following steps will be taken…
  • During Music the following steps will be taken…
  • During Library the following steps will be taken…

CLASSROOM PROJECTS INVOLVING QUESTIONABLE MATERIALS

  1. What are some possible classroom project materials that might contain an offending allergen?
  2. Is there a master list of the ingredients that are used in the classroom including art supplies, manipulatives and cleaning substances?

Format Examples:

  • Coordination between the teacher and parents will be stressed to avoid classroom projects that may contain allergens.
  • Unsafe project materials are…
  • If it is discovered that an unsafe material is accidentally being used, the following steps will be taken…

CLASSROOM MANIPULATIVES

  1. If classroom teachers make their own manipulative from food substances (ex. play dough, silly putty, “glurch,” what measures will be taken to ensure the absence of the allergen in the base ingredients?
  2. Are the classroom manipulatives washed periodically throughout the year?
  3. Will the parents be willing to help clean or make the manipulatives?
  4. What steps will be taken if the manipulative cannot be wiped down or washed?

Format Examples:

  • The parent requests to clean all classroom manipulatives.
  • The parent has offered to…

BIRTHDAYS

  1. Will birthdays be encouraged as non-food events?
  2. Will the parents of the child w/fa be notified in advance of any birthday celebration?
  3. Who will notify the parent of the child w/fa so that the parent of the child w/fa can make an alternative treat?
  4. Will other parents be expected to pre-arrange any birthday celebration with the classroom teacher?
  5. Will treats be given at the end of the day? Does this pose other risks on the bus?
  6. What steps will be taken if an allergen that exceeds the established safety perimeters enters the classroom during a birthday party?

Format Examples:

  • Birthdays will be encouraged to be non-food events (or with as little food as possible.)
  • Should a parent wish to bring in food, the following steps will be taken…
  • Parents and the teacher will be encouraged to communicate openly and in advance about birthday events in the classroom involving food.

HOLIDAY PARTIES AND CELEBRATIONS

  1. Will holiday parties and celebrations be encouraged as non-food events?
  2. Will the parents of the child w/fa be notified in advance of any party or celebration?
  3. Who will notify the parent of the child w/fa so that the parent of the child w/fa can make an alternative treat?
  4. Will other parents be expected to pre-arrange any birthday celebration with the classroom teacher?
  5. Will treats be given at the end of the day? Does this pose other risks on the bus?
  6. What steps will be taken if an allergen that exceeds the established safety perimeters enters the classroom during a party or celebration?

Format Examples:

  • Holiday parties and celebrations will be encouraged to be non-food events.
  • The parent of the child with food allergies will volunteer to be room-mom whose duties include assisting the teacher in coordinating holiday parties and celebrations.
  • Holiday Parties & Celebrations include but are not limited to…

ANIMALS

  1. Do any animal pose a health issue for the child?
  2. Should the child be allowed to handle animals?
  3. Should the child be allowed to wash his/her hands after handling an animal?

Format Examples:

  • If an animal is brought into the classroom, the child will…
  • After handling an animal, the child will…

STAFF

  1. Should the school staff in general be made aware to the threat that the allergen poses to the child?
  2. How will this be accomplished?
  3. Who will accomplish this?
  4. Should the school staff be asked to modify their behavior in any way?

Format Examples:

  • All staff will be urged to … (with regard to consuming the allergen).
  • All staff will be informed about the child’s allergy and the “no food” from outside the home policy.
  • Staff members will be asked to wash their hands after eating lunch if they have eaten a known allergen (ex. peanut butter).

OUTSIDE VISITORS

  1. How and when will outside visitors be informed of the child’s allergy condition?
  2. How will parents of child w/ fa be informed of outside visitors?

Format Examples:

  • The teacher will try to anticipate potential problems and confer with the parent of child w/fa as needed.
  • All outside visitors will be given a 3-fold brochure with a school map, school information and a statement about the presence of children with food allergy (and other allergies)?
  • All outside visitors will be expected to …
  • Example of Outside Visitors include…

SPECIAL & CULTURAL EVENTS

  1. What kind of thinking and risk assessment needs to be practiced with regard to special and cultural events?
  2. What are the implications of these events for the child, and what type of steps do parents and staff members need to take to promote safety?
  3. Are there any school-wide groups (ex. PTO) that can assist in keeping track of these events?
  4. How will staff members manage allergens during community service projects such as food drives?
  5. How staff members manage allergens during community service projects such as fundraiser where participants sell food items such as candy, cookies, etc.)?

Format Examples:

  • All special events that take place in the classroom need…
  • The child’s parents will provide snacks and treats for the child during any special and cultural events.
  • Examples of Special & Cultural Events include but are not limited to…

CLEANING OF CLASSROOM & CAFETERIA BY CUTODIAL STAFF

  1. What expectations will the principal have for the custodial staff and their methods of cleaning the cafeteria tables?
  2. Will the custodians use new cleaning cloths to cleanse the lunch tables?
  3. What steps will be taken thoroughly clean the cafeteria floors each day?
  4. Is there a peanut free table in the cafeteria, and will extra care be given to not cross-contaminate this table during cleaning?
  5. What cleaning solution will the custodians use?
  6. What steps will the custodians take when cleaning tables in the classroom of the child w/fa to reduce the risk of bringing allergens into the classroom?
  7. Will some basic cafeteria rules (management policy) that reinforce general safety rules be posted in the cafeteria?

Format Examples:

  • The classroom floor will be cleaned each night in the following way…
  • The classroom desks will be cleaned each night in the following way…(disposable wipes)
  • The cafeteria floor will be cleaned the following way…
  • The cafeteria tables will be cleaned the following way…(disposable wipes)

ASSEMBLIES

  1. What steps should be taken during an assembly to reduce risk of allergen exposure?

Format Examples:

  • Assemblies need to be thought through ahead of time in terms of potential risk.
  • The child will not be sent into another classroom without being accompanied by either the classroom teacher or a trained instructional aide.
  • When attending special events within the building, the child will be accompanied by his/her teacher or another responsible adult who is aware the child’s allergy condition.

FIRE DRILL

  1. What are the fire drill procedures?
  2. Who will the child w/fa line up with?
  3. Who will have the Medicine Kit?

Format Examples:

  • In the event of a fire drill, or a fire, the following procedure should be followed with regard to the Medicine Kit and responsible adult on duty…

CAFETERIA – LUNCH TIME

  1. Will the parents request particular allergens be removed from the lunch menu to reduce risk?
  2. Will the child wash his/her hand before eating?
  3. Will there be peanut/nut free tables? (allergen free tables or sections of tables)
  4. Where do the parents want the child to sit?
  5. With whom do the parents want the child to sit?
  6. With whom do the parents not want the child to sit?
  7. Will there be dedicated allergen free tables, or allergen free zones at a lunch table?
  8. Should the child sit in a well-ventilated area?
  9. Should the child not sit near a garbage can?
  10. Should the child not be expected to wipe down his/her table?
  11. Will the child w/fa be allowed to purchase any food or drink from the cafeteria?

FIELDTRIPS

  1. Will it be stated that under no circumstances is the child to eat any food or drink any beverage on a fieldtrip unless it the child’s parents supply it.
  2. Will it be stated that the EpiPen Jr. must be with the child on all fieldtrips, both long and short?
  3. Will the teacher coordinating the fieldtrip be required to investigate the fieldtrip destination and perform an “allergen risk assessment” with the parents well in advance of the fieldtrip to prevent risk of exposure to the offending allergen?
    1. Possible allergen risk assessment questions that administrators, teachers and parents can ask the director of the fieldtrip destination (Ex. child with peanut and tree nut allergy):
      1. Are peanuts or tree nuts displayed at the site?
      2. Are peanuts or tree nuts used in any of demonstrations or as feed for any animals?
      3. Are there any hands-on activity areas that use peanuts or tree nuts?
      4. Are the ingredients and substances that students touch peanut and tree nut free?
      5. Will the staff or guests at the fieldtrip site be handing anything out to children?
      6. How will lunches be stored on the bus ride to the fieldtrip destination?
      7. Who will be responsible for storing and distributing the children’s lunches?
      8. How will the child w/fa’s lunch be managed?
      9. Are there bathrooms nearby with soap for hand washing prior to and after eating?
  4. Who will be responsible for carrying and administering the medications in an emergency situation?
  5. Will medications, authorizations and emergency care plans be routinely sent with classroom teachers for all medically involved students when leaving the school grounds for any reason, including brief walks and hikes.
  6. Do the parents always want the child’s regular classroom teacher to be his or her proctor on a fieldtrip?
  7. Do the parents always want the child’s regular classroom teacher to carry the Medicine Pack?
  8. Do the parents always want to be able to accompany the child on a fieldtrip, but not be responsible for a whole group of children?
  9. Will all teachers and other adults responsible for children on the fieldtrip review the Emergency Healthcare Plan prior to each fieldtrip?
  10. Will a list of who will administer the EpiPen Jr. in the event of an emergency will be made for each fieldtrip taken since different adults will be involved each time?
  11. Will the parents request that a route to the nearest hospital always be mapped out before the child participates in a fieldtrip?
  12. Will this route be given to the bus driver?
  13. How would the teacher contact 911?
  14. Will the teacher carrying the medicine pack carry a charged cell phone?
  15. What steps will be taken if 911 cannot be reached in the event of an emergency?

PART I: INSTRUCTIONAL AIDS

  1. Do the parents think the child needs a dedicated peanut/nut free computer or keyboard?
  2. Should any other children with food allergies wash his or her hand before using the computer?
  3. Will the parents request that discrete desks be used in the child’s classroom instead of shared tables?

Format Examples:

  • One designated computer will be used by…
  • A package of wipes will be next to the computer to be used …

PART J: SUSTITUTE TEACHERS AND NURSES

  1. Will the parents be informed if the regular classroom teacher is going to be absent?
  2. How and by whom will the parents be informed?
  3. Will the parents be informed if the nurse is going to be absent?
  4. How and by whom will the parents be informed?
  5. Who will explain the EHP to the substitute?
  6. Is the substitute teacher even qualified or even allowed to administer any emergency medical medication?
  7. Who will administer the medication?
  8. What is the procedure for the EHP if both the regular classroom teacher AND the nurse are absent?
  9. Who will inform the substitutes of the EHP in the event the regular classroom teacher AND the nurse are absent?
  10. Who will explain the EHP to the substitutes?
  11. Will the parents be given the option of keeping the child home for the day if the regular classroom teacher and or the nurse are absent without being penalized?
  12. Will the child be given an appropriate amount of time to make up the work with the regular classroom teacher’s guidance?

Format Examples:

  • In the event a substitute is covering a class, the following procedure will be followed…
  • In the event a substitute nurse in covering the building, the following procedure will be followed…
  • The parent will be given the option of keeping the child home on day when a substitute nurse or teacher are in the building, and the child will not be penalized for days absent.
  • The parent will be given the option of keeping the child home on day when there is a fieldtrip, and the child will not be penalized for days absent.

PART K: BUS TRANSPORTATION

  1. Will the parents allow the child to ride the bus?
  2. Is the child allowed to carry his/her EpiPen Jr. and other emergency medications on the bus?
  3. Who will administer the EpiPen Jr. in the event of an emergency?
  4. When will the parents allow the child to ride the bus?
  5. Will the parents request that s/he is the last on picked up on the way to school and the first one dropped off on the way home?
  6. Will the parents request that the most viewable front seat near the driver be reserved for the child and a trustworthy friend?
  7. Will the parents request that the seat be thoroughly wiped down before the child enters the bus?
  8. Will the parents request that the no food eating policy be strictly enforced on the bus?
  9. If the superintendent of schools writes an annual note to parents in the local newspaper regarding “bus rules,” will parents ask the superintendent to reiterate the no food eating policy in his/her article?
  10. In the event of an emergency, will the parents create an emergency plan of action should a reaction occur on the bus?
  11. In the event of an emergency, where will the bus go exactly?
  12. In the event of an emergency, what route will the bus take to its destination?
  13. In the event of an emergency, who will the bus driver call and how?

PART L: SIGNATURE PAGE

  1. Will the parents include a page for signatures with the following statement? “This 504 Plan shall be reviewed and amended at the beginning of each school year or more often if necessary.”
  2. Will the parents include the signatures of the following headings and individuals:

This 504 Plan has been Reviewed by and this IHP has been Approved by:

_______________________ __________ Physician’s Name and Date

This 504 Plan has been Approved and Received by:

_______________________ __________ Parent’s Names & Date

This 504 Plan has been Approved and Received by:

_______________________ __________ School Representative and Title & Date

PART M: SECTION 504 OF THE REHABILITATION ACT OF 1973 & PARENTAL RIGHTS

  1. Will the parents be given a copy of Section 504 of the Rehabilitation Act of 1973? Direct Link: http://www.ed.gov/offices/OCR/regs/34cfr104.html
  2. Will the parents ask the 504 Coordinator to explain the various sections of the 504 Document and how they pertain to the child who is protected under Section 504?
  3. Will the parents ask for a copy of the school district’s document, “The Rights of Parents” under Section 504?

PART N: COVER LETTER

  1. Will there be a cover letter included with this 504 Plan?
  2. Will the cover letter state which staff members in the building and other school related personnel the parents want to read this plan?
  3. Will the cover letter explain to whom individuals should go if they have a question about the 504 Plan?
  4. Will the letter explain what anaphylaxis is, and why it is vital that teachers read the entire plan?
  5. Will the principal write this letter?
  6. Will teachers have access to the 504 Plan well in advance of the beginning of the school year so they have time to read it, ask questions and make suggestions?
  7. Which individuals in the school context would the parents like to have access to the full 504 Plan?

PART O: ADDITIONAL RESOURCES

  1. Are there additional documents that provide important information?

Examples:

  • List of other words for peanuts and tree nuts and high-risk foods.
  • List of the possible ways of cross-contamination.
  • List of tips to help teachers create a supportive learning environment for the child with food allergy.
  • Articles that help all school staff understand the serious nature of food allergy.
  • Professional training materials about food allergy including books, videos, and school resources sets.

Copyright © 2001-2002 Rhonda Riggott Stevens
All Rights Reserved
Reprint with Permission Only
Rhonda Riggott Stevens, MA
Version 5, Revised: 11-22-02