Seizure Action Plan For School Page 4
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4STUDENTS TRANSPORTED WITH SPECIAL EQUIPMENT/NEEDS
DRIVER/ATTENDANT INFORMATION SHEET
STUDENT NAME :
SCHOOL:
___________________
ADDRESS:_____________________________________________
TEACHER: __________________
PARENT/GUARDIAN:____________________________________
AM ROUTE:____PM ROUTE:____
HOME PHONE #:____________
WORK #:__________
CELL #:_________________________
EMERGENCY CONTACT:________________
PHONE:________
OTHER PHONE:_________
PHYSICIAN:___________
PHYSICIAN TEL:__________
PHYSICIAN FAX:___________
SPECIAL EQUIPMENT OR MEDICAL NEEDS ON BUS
I.E. OXYGEN TANK, WHEELCHAIR, SEIZURES, GO-BAGS, ETC.- PLEASE INCLUDE SIZE AND DIMENSIONS OF ALL EQUIPMENT
EMERGENCY BUS PLAN
IF YOU SEE THIS
DO THIS
BEHAVIOR PLAN
:________________________________________________________
BEHAVIOR OR DISABILITY
INTERVENTION TO MANAGE THE BEHAVIOR/DISABILITY
OTHER SPECIFIC NEEDS FOR SAFELY TRANSPORTING STUDENT
DOCUMENTATION OF DRIVER/ATTENDANT TRAINING
DATE
DRIVER/ATTENDANT NAME
NURSE/SCHOOL OFFICIAL
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