Anaphylaxis Risk Minimisation Form
Child’s Name:      	
Child’s Date of Birth:      	Child’s Year / Class:      	
Trigger	Risk	Service Risk Minimisation Strategy	

 Latex	 Low
 Moderate
 High	Service will only use Non-latex / Vinyl gloves.
Non-latex balloons to be used.	

 Insect Stings	 Low
 Moderate
 High	Risk assessments are done on all indoor and outdoor play areas.
Specify play areas that are lower risk and encourage the child and their peers to play in these areas.
Insect Spray to deter bites when outside to be used.	

 Herbal Remedies	 Low
 Moderate
 High	Medication is not given to child unless previously authorised by a parent or guardian.
All medication must be supplied in original container with a dispensary label, displaying child’s name and recommended dosage.	

 Medication	 Low
 Moderate
 High	Medication is not given to child unless previously authorised by a parent or guardian.
All medication must be supplied in original container with a chemist label, displaying child’s name and recommended dosage.
A ‘Medication Authority and Administration Form’ must be completed by the parent and match the dispensary label on the medication.	

 Food & Food Preservatives	 Low
 Moderate
 High	Child to bring food from home for meals.
Service to offer foods with minimal/no preservatives.
Educators will discourage sharing of foods.
Art and craft resources to be checked before being given to children such as egg cartons, playdough etc.
Service will not offer nut-based products such as Nutella and Peanut Butter.	

 Sunscreen	 Low
 Moderate
 High	Child to bring their own with their name clearly labelled.
If they do not supply sunscreen the child will remain in sun safe areas.

 Other:	 Low
 Moderate
 High		

Parent Name:      						Date Form Completed: