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    Western Community Unit School District #12

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Nurse's Office

District Information

  • Calendar
  • Recent News
  • Board of Education
    • Meetings
    • BOE Policy
    • IASB Board Member Qualifications
    • Freedom of Information Act
  • Business & Finance
    • Documents
  • Departments
    • Buildings & Grounds
    • Technology
      • Articles
      • Links
      • 1:1 with iPads
    • Art
  • Handbooks
  • District Report Card
  • Employment Opportunities
  • Library
  • Lunch Menus
  • Nurse's Office
  • PBIS
    • Elementary PBIS
    • Junior High PBIS
    • High School PBIS
  • District Staff
  • Registration Forms
    • Vehicle Registration
    • Kindergarten Preregistration
  • Documents
  • Resources
    • 5Essentials Survey
    • Western Home Internet Access
    • Homeless Act Information
  • Handbook

District 504 Forms

  • Western 504 Teacher Evaluation
  • Western Parent Request for 504 Evaluation Form

District Health Check Off Forms

  • 2023_ All Health Requirements.pdf
  • 2023_ New Student Health Check Off.pdf
  • 2023_ Pre-K Health Check Off.pdf
  • 2023_ Kindergarten Health Check Off.pdf
  • 2023_ 2nd grade Health Check Off.pdf
  • 2023_ 6th grade Health Check Off.pdf
  • 2023_ 9th grade Health Check Off.pdf
  • 2023_ 12th grade Health Check Off.pdf

District Health Action Plans

  • Asthma Action Plan
  • Asthma Questionnaire
  • Bee Sting Allergy Action Plan
  • Food Allergy Action Plan
  • Seizure Action Plan
  • Seizure Questionnaire
  • Western Asthma Action Plan

Illinois Health Forms

  • Child Health Exam Form
  • Child Health Exam Form (Spanish Version)
  • Childhood Lead Risk Questionnaire
  • IL Dental Exam Form
  • IL Dental Exam Waiver Form
  • Illinois Certificate of Religious Exemption Form
  • Illinois Eye Exam Form
  • Illinois Eye Exam Waiver Form
  • Illinois Sports Physical Form

Medication Authorization

  • Medication Authorization Form
  • Medication Administration Guidelines at Western CUSD 12

Peanut Allergy Resources

  • Classroom Peanut Letter
  • Peanut-Free Snack List
  • My Classmate Has a Food Allergy
  • My Student Has a Food Allergy

Western Immunization Summary

  • Western District Immunization Summary 2019-2020

Asthma Protocol

Western CUSD 12 is formally requesting parent/guardians of a student with an asthma diagnosis to submit an Asthma Action Plan completed by student’s health care provider to the Health Office. This plan is written and developed by a student’s medical provider to help control the student’s asthma and gives detailed instructions on how to treat Asthma symptoms. This request is stemming from Illinois Public Act 099-0843, which requires schools to request this information on all students with a diagnosis of Asthma. Illinois Public Act 099-0843 also required School Districts in Illinois to develop an “Asthma Episode Emergency Response Protocol,” which are the procedures to provide assistance to a student experiencing symptoms of wheezing, coughing, shortness of breath, chest tightness, or breathing difficulty. More information on Illinois Public Act 099-0843 can be located on the Illinois General Assembly website. If questions arise regarding this, please contact the School Nurse at 217-335-2323 or contact your student’s building administrator.

Asthma Protocol

Western Concussion Protocol

  • Concussion Return to School Health Care Prover
  • Concussion Signs and Symptoms Check List
  • Heads up- Student Returning to school after concussion for Staff-Fact Sheet
  • Heads up-signs and symptoms of concussion
  • HeadsUp-Concussion information for parents-student
  • HeadsUpConcussion- Parent information
  • HeadsUpConcussion- School Professionals Fact Sheet
  • HeadsUpConcussion-Action Plan
  • HeadsUpConcussion-Coach Fact Sheet
  • HeadsUpConcussion-High School Athlete Fact Sheet
  • HeadsUpConcussion-Middle School Athlete Fact Sheet
  • Western Concussion Management Protocol
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