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Section 504 Plan For student with peanut allergy Student Name: Georgia Age: 7 School Name: Monsour Elementary School Grade: 2nd Date Plan Written: 9/29/2017 Date Plan to be Revised: 9/29/2018 Documentation of Diagnosis: A physician has provided documentation that reports a sever peanut allergy. The school and ER have additional documentation regarding ambulance transfers from school to the hospital due to allergic reaction three times
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  Section 504 Plan For student with peanut allergy Student Name: Georgia Age: 7 School Name: Monsour Elementary School Grade: 2 nd  Date Plan Written: 9/29/2017 Date Plan to be Revised: 9/29/2018 Documentation of Diagnosis : A physician has provided documentation that reports a sever peanut allergy. The school and ER have additional documentation regarding ambulance transfers from school to the hospital due to allergic reaction three times within two years. Georgia was seated at a lunch table where peanuts had previously been placed but she did not eat any peanuts to trigger a reaction. Section 504 Plan Support 1.   Is the student disabled as per Section 504 of Rehabilitation Act of 1973? X  Yes ___No If yes , describe nature of the conditions: Student has been diagnosed with a sever peanut allergy as per her evaluating physician 2.   Does the disability limit major life activities? X  Yes ___No If yes , which areas? Eating, breathing, learning (when removed from school due to reaction) Accommodations 1.   This plan and the student’s food allergy emergency plan must be fully implemented and modifies when necessary. 2.   All school personnel who work with Georgia and will be responsible for the care of Georgia will receive training to: a.   Recognize causes and reactions to the allergy b.   Recognize symptoms of allergic reactions c.   Respond to emergencies d.   Administer allergy related medications consistent with applicable regulations e.   Plans will be reviewed and instruction on implementation will be provided f.   Each teacher and other involved personal will provide a copy of the plan in the substitute folder 3.   Parents/guardians will be immediately notified of any allergic reactions. 4.   The appropriate related service provider will be immediately notified of any allergic reactions. 5.   Any EMS staff will be notified that the incident is a result of a sever peanut allergy reaction. 6.   Teacher and lunch room staff will prohibit sharing food and enforce disciplinary actions to those who expose or harass students with peanut allergies.  7.   In class activities and snack distribution will prohibit foods containing peanut content. 8.   Classroom entryway will display a peanut restriction sign so other teachers and student do not bring foods containing peanuts into the room. 9.   Teachers and parents of the students in Georgia’s classroom will receive two friendly reminders throughout the school year about food allergies and precautionary steps. 10.   Teacher will provide a print out of replacement snacks and keep an additional copy in the substitute folder. 11.   When gong on field trips, unless Georgia’s parent /guardian is going, a properly trained school personnel who can administer the medications will attend the trip. 12.   Food service activities will be monitored including; a.   Ensuring peanut-free food products with appropriate labels b.   Reading food labels to ensure peanut-free ingredients prior to prepping c.   Advanced meal planning d.   Training and reinforcing proper food handling procedures e.   Thorough cleaning will be enforced for the food preparation area and all tables and chairs in the cafeteria before and after each lunch period 13.   The cooking course will follow food service activities (listed above) and will provide peanut-free alternative cooking materials/activities for the 2 nd  grade class Georgia is in. 14.   All food containing peanuts will be stored in a separate room from the cooking class and the room will undergo thorough cleaning before Georgia’s class arrives. 15.   Allergen free tables will be available in the cafeteria and cooking classroom. 16.   In-class activities will be provided for Georgia and peers to interact and reduce feelings of rejection. 17.   Parents will be given opportunity to pack or have their student purchase peanut-free lunches and volunteer to be Georgia’s lunch buddy. a.   Teacher will closely monitor the student lunches to ensure no peanut ingredients before the students are seated at the lunch table b.   Teacher will track lunch buddy sign up days and send friendly reminders to the buddy parents Team Member Title Signature Administrator General Education Teacher Related Service Provider Parent/Guardian 1 Parent/Guardian 2 Other
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