Free Student Allergy List Template

Student Allergy List

INSTUTION NAME

[YOUR INSTUTION NAME]

NAME:   

[YOUR NAME]

DATE:          

[DATE]

Overview

This comprehensive list is designed to track, record, and manage student allergies to ensure their safety and well-being in school. It includes information about the student's specific allergies, emergency contact information, and an allergy management plan. The goal of this list is to provide key information to staff and faculty for proper understanding and prompt response to potential allergic reactions.

Student Allergy List

Student 1:

Student Information

NAME:

John Doe

CLASS:

Grade 9

Roll NO:

 012

Allergies:

Penicillin

 

Bee stings

Emergency Contact Information

Parent/Guardian Name

Relationship to Student

Contact Number

Jane Doe

Mother

(123) 456-7890

John Smith

Father

(987) 654-3210

Allergy Management Plan

Allergy

Triggers

Symptoms

Peanuts

Consumption of peanuts

Hives, Difficulty breathing

Bees

Bee sting

Swelling at sting site, Difficulty breathing

 Student 2:

Student Information

NAME:

Allen Johnson

CLASS:

Grade 10

Roll NO:

205

Allergies:

Penicillin

 

Bee stings

Emergency Contact Information

Parent/Guardian Name

Relationship to Student

Contact Number

Michael Johnson

Mother

(123) 456-7898

Emily Johnson

Father

(787) 654-3210

Allergy Management Plan

Allergy

Triggers

Symptoms

Dairy

Ingestion

Stomach cramps, nausea, diarrhea

Eggs

Consumption

Skin rash, swelling, difficulty breathing

 Student 3:

Student Information

NAME:

Emily White

CLASS:

Grade 6

Roll NO:

45

Allergies:

Dairy

 

Shellfish

Emergency Contact Information

Parent/Guardian Name

Relationship to Student

Contact Number

David White

Father

555-123-4567

Sarah White

Mother

555-987-6543

Allergy Management Plan

Allergy

Triggers

Symptoms

Pollen

Exposure to pollen

Sneezing, runny nose, itchy eyes

Dust

Exposure to dust

Coughing, wheezing, nasal congestion

Notes:

  • Keep this list updated regularly.

  • Ensure all staff members are aware of students' allergies.

  • Communicate allergy management plans to relevant staff and faculty.

  • In case of an allergic reaction, follow the provided treatment instructions promptly.

  • Notify parents/guardians immediately in case of an allergic reaction.

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