HomeMy WebLinkAboutOCDSB 287 - Student Medication LogOCDSB 287 (May 2023) Confidential When Complete
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Distribution: OSR
OCDSB 287: Student Medication Log
(References: P.108.SCO and PR.547.SCO, PR.548.HS and PR.632.SCO)
Student’s Name: Student Number:
School Name: Grade/Room:
Principal’s Name: Home Form Teacher:
Name of Medication: Dosage:
Date Medication Returned Home: Quantity of Remaining Medication Returned Home:
Month: Month: Month: Month:
Date Time Initial Date Time Initial Date Time Initial Date Time Initial
OCDSB 287 (May 2023) Confidential When Complete
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Distribution: OSR
Month: Month: Month: Month:
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 administrative 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. Questions regarding this form should be directed to the Principal of the School.
1. Entries to this form must be made each time medication is administered to the student.
2. Upon final administration of medication, place this form in the student's OSR (documentation file). Destroy the
form at end of school year.
3. Return empty containers, unused medication, and a copy of this form to the parent(s)/guardian(s) ensuring the
amount of remaining medication, and date returned, are indicated on this form.
Date Time Initial Date Time Initial Date Time Initial Date Time Initial
Student’s Name: Student Number:Name of Medication: Dosage:
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