This document provides a checklist for evaluating school employees on their administration of medication to students. The checklist includes steps like washing hands, checking the student's identity, verifying the medication label matches the log, checking expiration dates, giving the correct dosage, recording it, and re-locking the medicine cabinet. A school nurse signs off to confirm the employee has demonstrated each procedure competently.

1. Hartland Consolidated Schools
9525 Highland Road • Howell, MI • 48843
Medication Administration
Employee Evaluation
School______________________________________________
Name__________________________________________ Title______________________
Activity Performs activity in
accordance to guidelines
Does not comply with
written guidelines
Requires further
instruction & supervision
Wash hands before
procedure
Ask student to
identify self
Compare labeled
medication container
with medication log
Check expiration date
on label
Pour correct amount
of prescribed
medication
Recheck labeled
container and
medication log
Administer correct
dosage
Record medications
given on student
medication log
Final check of labeled
container and
medication log
Sign medication log
Re-lock medicine
cabinet
Signature of School Nurse
Initial and date indicates procedure has been demonstrated in a competent manner.