Form Rcjtc F 02 02 PDF Details

The RCJTC F 02 02 form is an important document created by the Renfrew County Joint Transportation Consortium, a body that coordinates transportation services in Pembroke, Ontario. Housed at 999 Cecelia Street and accessible through various means of communication, including phone, fax, and the internet, this consortium emphasizes the safety and preparedness of student transportation. The form caters specifically to students with medical needs, such as conditions that could lead to sudden changes in blood sugar levels. It captures essential details ranging from the student's name and classroom teacher to emergency contact information, highlighting the prioritization of contact attempts. It instructs on identifying signs and symptoms of distress and outlines immediate treatments to be administered, reflecting a meticulous approach toward student health and safety during transit. Moreover, the document specifies actions to take in extreme cases, like unconsciousness, reinforcing the consortium's commitment to safeguarding students' well-being. By collecting personal information under the Education Act, the form also assures the lawful management of this sensitive data, promising its use solely for purposes related to transportation, health, safety, and educational compliance. This comprehensive approach underscores the RCJTC’s dedication to delivering a secure and responsive transportation environment for every student.

QuestionAnswer
Form NameForm Rcjtc F 02 02
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesdiabetes action plan template, printable templates for diabetic education plans, blank printable diabetes sick day and emergency plan template, 1A4

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Renfrew County Joint Transportation Consortium

999 Cecelia Street, Pembroke, ON K8B 1A4

Telephone: 613.732.8419 Fax: 613.732.2874

Website: www.rcjtc.on.ca Email: trans@rcjtc.on.ca

F.02.02

Student’s Name:

 

 

 

 

 

 

Place Student’s

 

Classroom Teacher:

 

 

 

 

 

 

Picture Here

 

 

 

 

 

 

 

 

 

 

Parent/Guardian/Emergency Contacts:

 

 

 

 

 

 

 

 

 

(Prioritize calls, i.e. 1, 2, 3)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Names, please print)

 

 

 

 

 

 

 

 

 

Signs and Symptoms:

Sweating

Hunger

Other, please specify:

Trembling Headaches

Dizziness Blurred vision

Mood changes

Extreme tiredness/paleness

Optimum Level (Range) of Blood Sugar is

 

 

 

 

 

 

 

 

 

 

Location of Sugar Treatment

 

 

 

 

 

 

 

 

 

 

With Student

Other, please specify:

 

 

 

 

 

 

 

 

 

 

Select one treatment, provided by parent, from the following:

 

 

 

 

6 oz. (125 ml) of fruit juice/drink (junior juice box) OR

 

 

 

 

3 – 4 tsp. (10 – 15 ml) of sugar (3 – 4 packets) OR

 

 

 

 

6 oz. (125 ml) of regular pop (not diet type) OR

 

 

 

 

 

 

 

 

 

 

3 – 4 tsp. (10 – 15 ml) of honey OR

 

 

 

 

 

 

 

 

 

 

4 – 5 glucose tablets

 

Other

 

 

 

 

 

 

 

 

 

 

Wait 10 – 15 minutes. If there is no improvement, repeat the above treatment.

 

 

 

 

 

 

 

 

If the student is unconscious,

*Roll the student on his/her side

 

 

 

having a seizure or unable to swallow

*Call 9-1-1

 

 

 

 

DO NOT give food or drink

*Inform parents/guardians

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Rte #

 

AM

PM

 

 

 

 

 

 

 

 

Rte #

 

AM

PM

 

 

Original – School; Copy – Renfrew County Joint Transportation Consortium

The personal information you have provided on this form and any other correspondence relating to transportation is collected by the Renfrew County Joint Transportation Consortium (RCJTC) under the authority of the Education Act (R.S.O. 1990 c.E.2) ss. 58.5, 265 and 266 as amended. The information will be used to arrange appropriate transportation, and to give information to employees and transportation providers to carry out their job duties. In addition, the information may be used to deal with matters of health and safety or discipline and is required to be disclosed in compelling circumstances or for law enforcement matters or in accordance with any other Act. The information will be used in accordance with the Education Act, the regulations, and guidelines issued by the Minister of Education governing the establishment, maintenance, use, retention, transfer and disposal of pupil records. For questions about this collection, speak to the General Manager of the RCJTC, 999 Cecelia St., Pembroke, 613-732-8419.

Form RCJTC.F.02.02

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How to Edit Form Rcjtc F 02 02 Online for Free

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Put the requested particulars in the Select one treatment provided by, Other, Wait minutes If there is no, If the student is unconscious, Roll the student on hisher side, Rte Rte, AM AM, PM PM, Original School Copy Renfrew, The personal information you have, Form RCJTCF, and Page of part.

transrcjtc Select one treatment provided by, Other, Wait    minutes If there is no, If the student is unconscious, Roll the student on hisher side, Rte  Rte, AM AM, PM PM, Original  School Copy  Renfrew, The personal information you have, Form RCJTCF, and Page  of fields to fill out

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