In alignment with supporting a culture of innovation and continuous improvement, the following tools have been created for and may be used by school nurses. These culturally responsive, readily available translated forms provide equity through language access.
Sample Forms & Templates for the Health Office
| Form | Last Updated |
|---|---|
| Bio-Medical Waste Sample Plan | 03/12/2025 |
| Concussion Sample Handbook Information | 02/26/2025 |
| Concussion Symptom Monitoring Tool for Academics | 02/28/2025 |
| List of Trained Unlicensed Assistive Personnel | 08/22/2024 |
| Maine School Health Advisor Role Template | 06/06/2024 |
| Medication Administration Procedure for Field Trip | 08/22/2024 |
| Medication Error Reporting Form | 08/22/2024 |
| Medication Training Competency Checklist | 08/22/2024 |
| Medication Training for Field Trip Checklist | 08/22/2024 |
| Naloxone Training Skills Checklist | 03/11/2025 |
| Opioid Overdose Protocol Poster | 02/25/2025 |
| Reading a Medication Label | 7/29/2024 |
| Refrigeration Temperature Log | 08/22/2024 |
| Sample Medication Administration Procedure | 08/22/2024 |
Sample Forms for Families
Contact
Emily Poland, MPH, RN, NCSN
School Nurse Consultant
Coordinated School Health Team Leader
Email: Emily.Poland@maine.gov