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Workload Survey Questions 25/26SchoolSchoolSchoolSchool
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Total
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1. LEA
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a. Name
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b. In what county is your LEA?
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c. Is your LEA a district, charter, or private/parochial school?
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d. Does this report include data from schools that are not officially part of your LEA? If yes, specify the schools included.
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2. Please list numbers that best represent your LEA (district/charter/private)
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a. How many schools are in your LEA (district/charter/private)
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b. How many students in LEA? Oct 2025 data if possible
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3. Person Completing report
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a. Name
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b. Title
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c. Email
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d. If you are NOT the best contact for future school health workload report data questions please list contact information for that person. (leave blank if you are the best contact)
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e. Are you a licensed registered nurse in Utah whose primary role is to provide healthcare services to students in a school setting?
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i. Yes
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ii. No
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iii. No, but we do have school nurses in our LEA
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4. Indicate whether your LEA has formal, written policies for the following:
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a. Health and wellness policy
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b. Medication policy
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c. Administration of naloxone
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d. Administration of Epinephrine
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e. Traumatic head injury policy
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f. Is there a formal process to review and update health-related policies at least once every five years
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5. Are at least two staff members at each school site currently certified in CPR and First Aid through an authorized training program? R392-200-6(9)
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a. If no, how many schools do not have two staff members trained in CPR
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6. Total number of schools with AEDs:
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7. Beginning in 2029, Utah rule states a school shall ensure that each classroom and large gathering areas are equipped with bleed kits and have access to a first aid kit within the school's office and gymnasium or anywhere school administrators deem as appropriate.
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a. How many offices, gyms, and classrooms are in your school (and will therefore need a bleed kit)?
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b. How many Stop the Bleed kits do you currently have?
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DISPOSITIONS
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8. Report the total number of student health office visits for any health-related reason, including illness, injury, medication administration, mental health concerns, or screenings.
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Report the RECOMMENDED outcome of the visit. If you determined the student could return to class, but a parent chose to pick them up, do not count it as "sent home" because you did not send them home.
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Report numbers for the full school year.
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a. Number of student encounters/health office visits to RN resulting in:
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i. Students returned to class or staying in school
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ii. 911 Called
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iii. Student sent home
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b. Number of student encounters/health office visits to LPN resulting in:
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i. Students returned to class or staying in school
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ii. 911 Called
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iii. Student sent home
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c. Number of student encounters/health office visits to health aid/clerk (non-RN/ office staff):
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i. Students returned to class or staying in school
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ii. 911 Called
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iii. Student sent home
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MEDICAL CONDITIONS
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9. Students with certain medical impairments (see expanded definitions on last page). Each student should only be categorized once.
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a. Total number of students with health concerns
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Students with an identified health condition requiring occasional monitoring by the school nurse, but whose condition is generally stable and predictable. Ex. Parent reported condition that doesn’t require a Healthcare Plan.
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b. Total number of medically complex students:
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Students with unstable health conditions who require daily professional nursing services, an Individualized Healthcare Plan (IHP), or an Emergency Action Plan (EAP).
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c. Total number of medically fragile students:
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Students with life-threatening conditions requiring frequent or daily nursing care and one-on-one monitoring.
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d. Total number of nursing-dependent students:
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Students requiring continuous one-on-one nursing services to attend school safely (e.g., tracheostomy care, ventilator dependence).
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Adrenal insufficiency
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10. Answer the following questions for students diagnosed by a healthcare provider with adrenal insufficiency:
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a. Total number of students diagnosed with adrenal insufficiency by a licensed healthcare provider (ever):
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b. Total students with a 25-26 Adrenal Insufficiency Emergency Action Plan containing a medication order:
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c. Total students with adrenal insufficiency that have an IHP/EAP:
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d. Total students with adrenal insufficiency that have Section 504/IEP plans:
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e. Total students diagnosed with adrenal insufficiency who were chronically absent (missed 10% or more of the school year), regardless of the reason for absence.
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11. Total number of times hydrocortisone was administered at school for a student with adrenal insufficiency:
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a. Stress dose hydrocortisone (oral tablets)
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b. Emergency hydrocortisone injections
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Allergy- Anaphylaxis
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12. Answer the following questions for students diagnosed by a healthcare provider with an anaphylactic allergy to anything
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a. Total Diagnosed with an anaphylactic allergy by healthcare provider (ever):
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b. Total students with a 25-26 Allergy and Anaphylaxis Emergency Action Plan containing a medication order
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c. Total students with an anaphylactic allergy that have an IHP/EAP:
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d. Total students with an anaphylactic allergy that have Section 504/IEP plans:
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e. Total students diagnosed with anaphylaxis who were chronically absent (missed 10% or more of the school year), regardless of the reason for absence.
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13. Utah law (26B-4-406(5a) requires schools to have stock epinephrine available. This is epinephrine that can be used for any student who experiences a severe allergic reaction at school.
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a. How many schools currently carry stock epinephrine?
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b. How many do not?
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14. Where was the injectable stock epinephrine purchased for your LEA? Note: If parent provided, this means a separate epinephrine for use with any student, not a student’s personal medication.
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a. EpiPen 4 Schools
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b. Local pharmacy
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c. Online
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d. Other
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14 (a) How long did it take to receive the EpiPen4Schools shipment, if applicable?
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a. Less than 1 month
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b. 1-2 months
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c. 2-6 months
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d. More than 6 months
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e. I don't know
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f. NA
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15. Please enter the number of individual student-specific epinephrine orders in your LEA.
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a. Total number of student-specific orders for injectable epinephrine:
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b. Total number of student-specific orders for nasal epinephrine:
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16. Total number of staff members trained to administer injectable epinephrine (include general staff trained and student specific):
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17. Total number of times epinephrine was administered at school:
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a. Injectable number