VIC Recognition Checklist Form

The Asthma Foundations of Australia invite you to become / continue to be an Asthma Friendly School. Please refer to the Asthma Friendly Schools (AFS) program guidelines here, and work with the Asthma Foundation VIC to complete the following checklist.

Send this via the form below to provide evidence that you have met all 8 essential criteria to be Asthma Friendly and receive a certificate of Recognition valid for the next 3 years.

The evidence supplied on this form contributes to the identification and sharing of good practices and ensures the quality and integrity of the AFS program.

# Required Fields
School
School: #
Campus (if applicable):
Address: #
Address Line 2:
City: #
State: #
Postcode: #
Contact Details: Phone: #
Fax:
Email: #
Website:
Principal: #

Key Contact Person
Contact Name: #
Position:
Contact Details Email: #
Preferred Contact Method:
Times:

School Details

Government
Catholic
Independent Other

Primary
Secondary
Combined Other
Specialisation (if any):
Year Levels Range:
Number of Staff: #
Local Council / Shire:

Number Of Students
Total: #
Students with asthma*:
CALD Students:
CALD Students with asthma*:
Indigenous students:
Indigenous Students with asthma*:
* (Please estimate if actual numbers unknown)
CALD stands for students from Culturally And Linguistically Diverse backgrounds.

PLEASE INDICATE WHICH OF THE FOLLOWING IS APPLICABLE:
Our school is applying for Recognition as an Asthma Friendly School for the first time.
We are currently an Asthma Friendly School applying for renewal of our Recognition.

Principal Declaration
# As the Principal I declare that I am in agreement with the evidence of achievement of the Asthma Friendly Schools program criteria provided on this form.
Person completing form:
Position:

Please tick all applicable boxes in responses.
Return form only when ALL 8 essential criteria have been achieved.

ESSENTIAL CRITERIA

1. Asthma education is provided for all school staff.
# Staff have attended a 1hr asthma training session provided by an authorised AFS trainer for The Asthma Foundation ACT.
Date #
Number of staff trained: #
Trainer #

Note that at least 75% of staff must be asthma trained for a school to be Asthma Friendly

2. Asthma Action Plans and/or Student Asthma Records for each student with asthma are actively encouraged and kept in a central location.
Up to date asthma health information is sought for each student with asthma
# When asthma indicated on school health information records
# When enrolled
Central location of Asthma Records: #
# School staff have appropriate access to asthma information for students in their care

3. Asthma First Aid posters are on display
Places where Asthma First Aid Posters are displayed:
Staff Room
First Aid Centre
Gym/PE Area
Reception
Other:

4. Students with asthma are encouraged to have their medications readily available and safely stored at all times.
# Appropriate age/ability students can carry or directly access (e.g. desk, bag) their medication
# Medication stored by the school is clearly labelled.
Location

5. A blue reliever puffer and spacer device(s) are available for emergency use.
# Kits* are stored throughout the school in known locations.
Number of Kits: #
# A kit accompanies all off-site, school based activities (e.g. excursions, sports, camps)
Kits are carried by staff when on yard duty
An Asthma Emergency Kit is stored with each First Aid Kit in the school
Each kit* contains
# Blue reliever puffer
# Spacer
# Alcohol swabs
# Instructions for use
* kit refers to Asthma Emergency Kit

6. A plan is in place for managing asthma during school sporting activities, excursions or camps.
Our school's plan / policy ensures,
# Trained staff able to manage an asthma incident are present at all school activities
# An Asthma Emergency Kit is always accessible
# Asthma records are up-dated and copies are taken on all camps
Catering staff are notified of any asthma trigger food allergies affecting students

7. Asthma related information is provided through the school to parents/carers that contributes to the quality of life, health outcomes and well being for their children.
Asthma Foundation information is distributed to parents
Asthma information supplied by the Foundation is regularly included in the school newsletter
An asthma information display is set up at reception and/or at school events
Promotion of the Asthma Foundation website and services
Asthma information session for parents is offered through the school
Other strategies:

8. Asthma Friendly Schools program teaching resources are used as part of the schools health curriculum.

Please select a minimum of one of the following options:

Primary resource: Asthma Can't Stop Me
Mission Asthma
Other
Secondary resource: Living With Asthma
Air Traffic Control
Other
For each school year, asthma education occurs for,
all students
specific year levels:
specific subjects:
Other


RECOMMENDED CRITERIA

9. Potential asthma triggers are minimised within the school environment.
Our school takes measures to minimise the impact of known and potential asthma triggers
Our school is interested in developing measures to address asthma triggers

10. School becomes a community member of the Asthma Foundation
Our school is a member / partner of the Asthma Foundation
Our school is interested in becoming a member / partner of the Asthma Foundation

Click Submit only when ALL 8 essential criteria have been achieved



Asthma Friendly is a registered trademark of the Asthma Foundations of Australia.