HPSE Program Booklet Overview/Benefits - Jefferson County Public ...

2013-14
Health
Promotion
Schools of
Excellence
2013-14
Health Promotion Schools of Excellence
HPSE Data Reporting Sheet
Elementary Schools
Required CSH
Component
Dental exams for 5- and 6-year-olds
Vision exams for 3-, 4-, 5-, or 6-yearolds
upon initial entry
Physical exams for initial entry and sixth
grade
Seasonal Flu Clinic
Immunizations
Baseline Data
(from 2012-13 school year)
# with:__________________
# without:_______________
Total:
# with:__________________
# without:_______________
Total:
# with:__________________
# without:_______________
Total:
# of students:____________
# of staff:________________
# with: __________________
# without:_______________
# expired:________________
Total:
End-of-Year Data
# with:__________________
# without:_______________
Total:
# with:__________________
# without:_______________
Total:
# with:__________________
# without:_______________
Total:
# of students:____________
# of staff:________________
# with: __________________
# without:_______________
# expired:________________
Total:
Hand-washing education # of classrooms: # of classrooms:
HPSE Staff Wellness Survey # completed: # completed:
List the program and the number of staff
members participating in the Health
Promotion for Staff activity.
# of staff members: # of staff members:
Does your school currently recycle? If
yes, what materials are recycled?
(Circle one.) Yes No
List materials:
(Circle one.) Yes No
List materials:
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