NEOSHO R-5 SCHOOL DISTRICT

Individualized Emergency Management Plan

(IEMP)

This form is for students with any health issues which may require specific interventions, or if the student has a documented allergy to foods or insect stings, or carries an epi-pen.

Student                                                                                       Grade/Teacher

Physician                                                                                    Physician's phone

Parent/Guardian                                                                        Contact number

Parent/Guardian                                                                        Contact number

Other emergency contact                                                          Phone

Diagnosis or condition requiring plan

Preferred Hospital

When this happens...                                                                   Do this...

IF AN EMERGENCY OCCURS:

1. STAY WITH THE STUDENT

2. CALL FOR HELP, CONTACT SCHOOL NURSE, OR 911

3. THE FOLLOWING STAFF MEMBERS ARE TRAINED TO DEAL WITH EMERGENCIES