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Seizure Action Plan

Effective Date

This student is being treated for a seizure disorder. The information below should assist you if a seizure occurs during
school hours.
Student’s Name
Date of Birth
Parent/Guardian

Phone

Cell

Other Emergency Contact

Phone

Cell

Treating Physician

Phone

Significant Medical History

Seizure Information
Seizure Type

Length

Frequency

Seizure triggers or warning signs:

Description

Student’s response after a seizure:

Basic Seizure First Aid

Basic First Aid: Care & Comfort
Please describe basic first aid procedures:

❒ Yes

Does student need to leave the classroom after a seizure?
If YES, describe process for returning student to classroom:

❒ No

Stay calm & track time
Keep child safe
Do not restrain
Do not put anything in mouth
Stay with child until fully conscious
Record seizure in log

For tonic-clonic seizure:
• Protect head
• Keep airway open/watch breathing
• Turn child on side

Emergency Response
A “seizure emergency” for
this student