Diabetes Forms and Information

Diabetes Checklist for Administrators and Nursing Support Services Information

Provincial Standards: Supporting Students with Type 1 Diabetes in the School Setting
Administrators should be familiar with this document.
Provincial standards provide the foundation upon which individual boards of education develop policies and procedures that address the unique needs of the student population and characteristics of the communities they serve. Local policies outline, more specifically, the procedures and processes unique to each school district.

Diabetes Support Plan and Medical Alert Information
This form is to be completed by ALL parents of students with Type 1 Diabetes. It is used as a communication tool for parents to share information with the school.

  • This form is required for ALL students with Type 1 diabetes.
  • Students who are receiving Nursing Support Services (NSS) Delegated Care do not need to complete page 3.
  • This form does NOT need to be completed by Diabetes Clinic staff, Nursing Support Service Coordinators or Public Health Nurses.

Diabetes Medication Administration Form
This form is required for any parent that is providing the school with a rescue medication (Baqsimi or Glucagon) OR any student who will have staff assisting or supervising with insulin administration. Parents must complete the form and get it signed by their child’s physician.

This form requires updating annually in September or anytime there is a change to to the student’s diabetic management in order to document physician approval regarding the following:

  • Administration of glucagon/basquimi by school staff
  • Administration of insulin by school staff for a student not able to complete the task (NSS Delegated Care)
  • Supervision by school staff of a student self-administering insulin who is not yet fully independent in the task (NSS Delegated Care)

Managing Low Blood Sugar is to be posted in visible locations in the school.

Power Point – General Information about Diabetes for School Personnel (⇐ follow this link and then click on the link on the right side bar – as picture below indicates). All staff are to view the power point on an annual basis.









Provincial Standards: Supporting Students with Type 1 Diabetes in the School Setting  
Diabetes Care in School Settings: Evidence Informed Key Components