Anaphylaxis Emergency Plan (Individual)

Recommendation
  • In schools and other child care settings, each child at risk of anaphylaxis should have an Anaphylaxis Emergency Plan. Please click here.
  • The Anaphylaxis Emergency Plan should be signed by the parent or guardian, and if required, by the child’s physician.
  • There may be situations where individuals were given recommendations that differ from those outlined in this Anaphylaxis Emergency Plan. In these cases, specific instructions for treatment of symptoms and risk reduction strategies should be provided in writing by the child’s physician. Parents of allergic children should discuss individualized plans with their children’s school staff.
  • If an anaphylactic emergency occurs, both the school anaphylaxis plan and the Anaphylaxis. Emergency Plan should be reviewed and amended as necessary.
The Anaphylaxis Emergency Plan has two pages:
1. First page – form with the person’s photo and allergy information, signs and symptoms, brief action plan.
2. Second page – epinephrine auto-injector instruction sheet and contact information.

Please click here to download the pages.