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Allergy Action Form - Mundelein Coop Preschool

Allergy Action Form - Mundelein Coop Preschool 2026

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The document is a Food Allergy Action Plan for students at Mundelein Cooperative Preschool, detailing procedures for managing allergic reactions. It includes sections for identifying the student, their allergies, and emergency contacts. The plan outlines signs of allergic reactions, actions to take for minor and major reactions, and requires signatures from parents and a doctor.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the student's name and birth date in the designated fields at the top of the form.
Indicate any allergies by filling in the 'ALLERGIC TO' section, and provide the Epi-Pen expiration date.
Specify if the student is asthmatic by checking 'Yes' or 'No'. If yes, note if they are at high risk for severe reactions.
Review the signs of an allergic reaction listed on the form. This will help you identify symptoms quickly.
For minor reactions, fill in the symptoms and medication/dose to be administered, along with emergency contact information for parents and doctor.
For major reactions, clearly state suspected ingestion symptoms and medication/dose to be given immediately. Ensure to call 9-1-1 as instructed.
Finally, sign and date both parent’s and doctor’s signature sections to complete the form.

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2015	4.8 Satisfied (58 Votes)

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Who can administer allergy testing?

Testing done by an allergist is generally safe and effective for adults and children of all ages. The allergen extracts or vaccines used in allergy tests performed by allergists meet U.S. Food and Drug Administration (FDA) requirements.

Who completes an allergy action plan?

The action plans have been developed following an extensive consultation period with health professionals, support organisations, parents of food-allergic children and teachers. The plans are medical documents and should be completed by a childs health professional (and not by parents or teachers, for example).

Who can fill out an allergy action plan?

The plans are medical documents and should be completed by a childs health professional (and not by parents or teachers, for example).

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