OCDSB 287 - Student Medication Log
OCDSB 287 School Operations (June 2014) Confidential When Complete
Page 1 of 2
Distribution: OSR
Student Medication Log
(References: P.108.SCO and PR.547.SCO, PR.548.SCO and PR.632.SCO)
Student’s Name: Student Number
School Name: Grade/Room:
Principal’s Name: Home Form Teacher:
Name of Medication: Dosage(s):
Month: Month: Month: Month:
Date Time Initial
Date Time Initial
Date Time Initial
Date Time Initial
OCDSB 287 School Operations (June 2014) Confidential When Complete
Page 2 of 2
Distribution: OSR
Month: Month: Month: Month:
Date Time Initial
Date Time Initial
Date Time Initial
Date Time Initial
The personal information on this form is collected under the authority of the Education Act and will only be used to record the
administration of medication to the named student. Access to this information will be limited to those who have an administra tive need,
to the student to whom the information relates, and to the parent(s)/guardian(s) of the student who is under 18 years of age.