Report epi-pen administration

Schools must submit a written report to the Department of Public Health each time epinephrine is administered to a student or staff.

School Health Services Support

The Details   of Report epi-pen administration

How to report   Report epi-pen administration

You must report the incident online here.

Please note:

  • This form (and the link) Will change every school year. Please be sure to use the link to the current form.
  • Please do not include any names, dates of birth, or other details in this form that might permit someone to identify the person receiving the epinephrine.
  • Questions with an asterisk (*) are required. You must complete them in order to submit the form.

More info   for Report epi-pen administration

View reporting instructions and frequently asked questions: Epinephrine Administration Reporting (PDF) | (DOCX)

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