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
Middle and High Schools
Required CSH
Component
Physical exams for initial entry and sixth
grade
Seasonal Flu Clinic (if applicable)
Immunizations
Baseline Data
(from 2012-13 school year)
# with:__________________
# without:_______________
Total:
# of students:____________
# of staff:________________
# with: __________________
# without:_______________
# expired:________________
Total:
End-of-Year Data
# with:__________________
# without:_______________
Total:
# of students:____________
# of staff:________________
# with: __________________
# without:_______________
# expired:________________
Total:
Hand-washing education # of classrooms: # of classrooms:
Does your school currently recycle? If
yes, what materials are recycled?
(Circle one.) Yes No
List materials:
(Circle one.) Yes No
List materials:
HPSE Staff Wellness Survey # completed: # completed:
Staff members participating in Health
Promotion for Staff activity
# of staff members: # of staff members:
List program:
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