Medication Compliance School Audit Tool

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Medication Compliance Audit Tool
School
Date
Completed by
Tracking Form
Authorization Form (current year)
Date & count of
Drug/ Dose/Freq./Duration
Rx. Labeled
Meds
Student Initials
Exp. date
brought to
Drug,
Codes,
(List each med separately)
properly
secure?
school
dose,
Initials,
Health
Parent
Time
signature
Provider
A copy of the audit will be given to:
Notes
Date sent
School Staff :
School Principal :
School Director :
School Risk Manager :
Health Dept. Administration :
Medication Book :

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