Medical Risk Minimisation Plan
This plan has been developed in consultation with the child’s parents/guardians and is implemented to help protect the child identified as being at high risk of a medical emergency. It works in conjunction with the 'Medical Management Plan' and is part of the centre's 'Medical Conditions Policy' requirements under Regulation 90. Depending on your child's condition, you may be asked to upload an Action Plan.
Name of child
*
First Name
Last Name
Date of birth
*
/
Day
/
Month
Year
Photograph of child
*
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Please attach a recent photograph of your child, showing head and shoulders only, and without a hat.
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Identified medical condition(s)
*
Anaphylaxis
Asthma
Diagnosed Allergy
Suspected Allergy
Food Intolerance
Diabetes
Epilepsy
Other (provide details)
Other (provide details)
*
Anaphylaxis Treatment and Management
Please note that at the end of this section, you'll be asked to upload an Action Plan for your child's medical condition, to be completed and signed by your GP. Additionally, you will be required to provide us with an Epipen/Anapen to ensure it is readily available and accessible while your child is in our care. Please be aware that children cannot be enrolled and start at our centre unless both the action plan and Epipen/Anapen are provided.
Anaphylaxis allergen (specify one)
*
Can foods containing Precautionary Allergen Labelling (PAL) statements be eaten? (e.g., “May contain traces of…”)
*
Yes
No
Triggers
*
Potential reactions
*
Other issues to be aware of (e.g., Parties, celebrations, prizes, cooking activities, craft activities, excursions)
Does your child have another anaphylaxis allergen?
*
Yes
No
Anaphylaxis allergen (specify one)
*
Can foods containing Precautionary Allergen Labelling (PAL) statements be eaten? (e.g., “May contain traces of…”)
*
Yes
No
Triggers
*
Potential reactions
*
Other issues to be aware of (e.g., Parties, celebrations, prizes, cooking activities, craft activities, excursions)
Does your child have another anaphylaxis allergen?
*
Yes
No
Anaphylaxis allergen (specify one)
*
Can foods containing Precautionary Allergen Labelling (PAL) statements be eaten? (e.g., “May contain traces of…”)
*
Yes
No
Triggers
*
Potential reactions
*
Other issues to be aware of (e.g., Parties, celebrations, prizes, cooking activities, craft activities, excursions)
Does your child have another anaphylaxis allergen?
*
Yes
No
Anaphylaxis allergen (specify one)
*
Can foods containing Precautionary Allergen Labelling (PAL) statements be eaten? (e.g., “May contain traces of…”)
*
Yes
No
Triggers
*
Potential reactions
*
Other issues to be aware of (e.g., Parties, celebrations, prizes, cooking activities, craft activities, excursions)
Does your child have another anaphylaxis allergen?
*
Yes
No
Anaphylaxis allergen (specify one)
*
Can foods containing Precautionary Allergen Labelling (PAL) statements be eaten? (e.g., “May contain traces of…”)
*
Yes
No
Triggers
*
Potential reactions
*
Other issues to be aware of (e.g., Parties, celebrations, prizes, cooking activities, craft activities, excursions)
Please upload the Action Plan completed and signed by your child's GP
*
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Asthma Treatment and Management
Please note that at the end of this section, you'll be asked to upload an Action Plan for your child's medical condition, to be completed and signed by your GP. Please be aware that children cannot be enrolled and start at our centre unless the action plan is provided.
Asthma triggers
*
Asthma symptoms
*
What is the name of your child's preventer and/or reliever medication(s)? (e.g., Ventolin)
*
Preference for asthma medication for your child
*
Facility-supplied medication
Personal medication
Please upload the Action Plan completed and signed by your child's GP
*
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Diagnosed Allergy Management
Please note that at the end of this section, you'll be asked to upload an Action Plan for your child's medical condition, to be completed and signed by your GP. Please be aware that children with diagnosed allergies cannot be enrolled and start at our centre unless the action plan is provided. This requirement excludes allergies to grass, dust mite, and mould.
Diagnosed allergy (specify one)
*
Can foods containing Precautionary Allergen Labelling (PAL) statements be eaten? (e.g., “May contain traces of…”)
*
Yes
No
N/A
Triggers
*
Potential reactions
*
Other issues to be aware of (e.g., Parties, celebrations, prizes, cooking activities, craft activities, excursions)
Does your child have another diagnosed allergy?
*
Yes
No
Diagnosed allergy (specify one)
*
Can foods containing Precautionary Allergen Labelling (PAL) statements be eaten? (e.g., “May contain traces of…”)
*
Yes
No
N/A
Triggers
*
Potential reactions
*
Other issues to be aware of (e.g., Parties, celebrations, prizes, cooking activities, craft activities, excursions)
Does your child have another diagnosed allergy?
*
Yes
No
Diagnosed allergy (specify one)
*
Can foods containing Precautionary Allergen Labelling (PAL) statements be eaten? (e.g., “May contain traces of…”)
*
Yes
No
N/A
Triggers
*
Potential reactions
*
Other issues to be aware of (e.g., Parties, celebrations, prizes, cooking activities, craft activities, excursions)
Does your child have another diagnosed allergy?
*
Yes
No
Diagnosed allergy (specify one)
*
Can foods containing Precautionary Allergen Labelling (PAL) statements be eaten? (e.g., “May contain traces of…”)
*
Yes
No
N/A
Triggers
*
Potential reactions
*
Other issues to be aware of (e.g., Parties, celebrations, prizes, cooking activities, craft activities, excursions)
Does your child have another diagnosed allergy?
*
Yes
No
Diagnosed allergy (specify one)
*
Can foods containing Precautionary Allergen Labelling (PAL) statements be eaten? (e.g., “May contain traces of…”)
*
Yes
No
N/A
Triggers
*
Potential reactions
*
Other issues to be aware of (e.g., Parties, celebrations, prizes, cooking activities, craft activities, excursions)
Please upload the Action Plan completed and signed by your child's GP. (Allergies to grass, dust mite or mould do not require an Action Plan)
*
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Suspected Allergy Management
Please specify any suspected allergies and provide details
*
Food Intolerance Management
Food intolerance (specify one)
*
Can foods containing Precautionary Allergen Labelling (PAL) statements be eaten?
*
Yes
No
Triggers
*
Potential reactions
*
Other issues to be aware of (e.g., Parties, celebrations, prizes, cooking activities, craft activities, excursions)
Does your child have another food intolerance?
*
Yes
No
Food intolerance (specify one)
*
Can foods containing Precautionary Allergen Labelling (PAL) statements be eaten?
*
Yes
No
Triggers
*
Potential reactions
*
Other issues to be aware of (e.g., Parties, celebrations, prizes, cooking activities, craft activities, excursions)
Does your child have another food intolerance?
*
Yes
No
Food intolerance (specify one)
*
Can foods containing Precautionary Allergen Labelling (PAL) statements be eaten?
*
Yes
No
Triggers
*
Potential reactions
*
Other issues to be aware of (e.g., Parties, celebrations, prizes, cooking activities, craft activities, excursions)
Does your child have another food intolerance?
*
Yes
No
Food intolerance (specify one)
*
Can foods containing Precautionary Allergen Labelling (PAL) statements be eaten?
*
Yes
No
Triggers
*
Potential reactions
*
Other issues to be aware of (e.g., Parties, celebrations, prizes, cooking activities, craft activities, excursions)
Does your child have another food intolerance?
*
Yes
No
Food intolerance (specify one)
*
Can foods containing Precautionary Allergen Labelling (PAL) statements be eaten?
*
Yes
No
Triggers
*
Potential reactions
*
Other issues to be aware of (e.g., Parties, celebrations, prizes, cooking activities, craft activities, excursions)
Diabetes Treatment and Management
Please note that at the end of this section, you'll be asked to upload an Action Plan for your child's medical condition, to be completed and signed by your GP.
Type of diabetes (e.g., Type 1, Type 2, etc.)
*
What is your child's typical blood glucose monitoring routine?
*
Does your child use an insulin pump or injections for insulin administration?
*
Are there specific times of day when your child typically needs insulin or snacks to manage blood sugar levels? (Provide details)
*
Frequency of monitoring your child's blood sugar levels
*
Specific range of blood sugar levels that you aim to maintain for your child
*
How does your child recognise and treat low blood sugar (hypoglycemia) episodes?
*
What steps should be taken if your child experiences high blood sugar (hyperglycemia) levels?
*
Medication your child needs with them while at our facility (e.g., insulin, glucose monitoring supplies, etc.)
*
Specific storage requirements for insulin or other diabetes-related medications/supplies (Provide details)
*
Dietary restrictions or specific meal/snack requirements for managing your child's diabetes (Provide details)
*
How can we best communicate with you regarding your child's diabetes management while they are in our care?
*
Precautions or adjustments needed for physical activity to accommodate your child's diabetes (Provide details)
Other issues to be aware of (e.g., Parties, celebrations, prizes, cooking activities, craft activities, excursions)
Please upload the Action Plan completed and signed by your child's GP
*
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Epilepsy Management
Please note that at the end of this section, you'll be asked to upload an Epilepsy Management Plan for your child's medical condition, to be completed and signed by your GP.
Potential triggers
*
Potential symptoms
*
How should we respond in the event of a seizure?
*
Specific protocols or instructions for managing your child's seizures (Provide details)
How can we best communicate with you regarding your child's epilepsy management while they are in our care?
*
Other issues to be aware of (e.g., Parties, celebrations, prizes, cooking activities, craft activities, excursions)
Please upload the Epilepsy Management Plan completed and signed by your child's GP
*
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Other Medical Conditions Treatment and Management
Please provide further details about the other medical condition you mentioned earlier. At the end of this section, you'll be asked to upload an Action Plan for your child's medical condition, to be completed and signed by your GP, if emergency treatment is required.
Please specify
*
Triggers
*
Symptoms
*
How can we support your child in this regard?
How should we respond in the event of an emergency?
How can we best communicate with you regarding your child's medical condition management while they are in our care?
Other issues to be aware of (e.g., Parties, celebrations, prizes, cooking activities, craft activities, excursions)
Please upload the Action Plan completed and signed by your child's GP if the medical condition requires emergency treatment
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Do you give permission to display your child's medical information in our first aid area in the hub? This information would be readily accessible to our staff in case of emergencies.
*
Yes
No
Parent signature
*
Date
*
/
Day
/
Month
Year
Date signed
Educator signature
Date
/
Day
/
Month
Year
Date signed
Nominated Supervisor signature
Date
/
Day
/
Month
Year
Date signed
Submit
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