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The RCJTC F 02 02 form is an essential document designed to ensure the safe transportation and well-being of students within the Renfrew County Joint Transportation Consortium. This form collects important information including the student’s name and classroom teacher, which assists in identifying the individual needs of each student. Parents or guardians are asked to provide their contact information, prioritized for emergencies, ensuring that communication remains clear and prompt when needed. The form also addresses various health signs and symptoms, like sweating or dizziness, that could indicate a medical issue. It specifies the optimum level of blood sugar and includes treatment options to be provided, which empowers parents to decide the best course of action in case of incidents. Instructions on how to respond if a student is unconscious or having a seizure are straightforward, emphasizing the urgency required in emergency situations. Lastly, the form addresses how personal information is collected and used, ensuring compliance with the Education Act. This critical document protects student safety while helping transportation providers fulfill their responsibilities effectively.

Rcjtc F 02 02 Example

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

Page 1 of 1

Form Characteristics

Fact Name Description
Form Purpose This form is used by the Renfrew County Joint Transportation Consortium to document transportation details and health information for students.
Location The RCJTC is located at 999 Cecelia Street, Pembroke, ON K8B 1A4.
Contact Information For inquiries, the RCJTC can be contacted via telephone at 613.732.8419 or fax at 613.732.2874.
Email Address The provided email address for communication is trans@rcjtc.on.ca.
Student Identification This form requires the student's name and classroom teacher to ensure proper identification.
Health Symptoms It lists signs and symptoms related to blood sugar levels, including sweating and trembling.
Treatment Options The form specifies various treatment options for low blood sugar, such as fruit juice or glucose tablets.
Emergency Protocols Instructions on what to do if the student is unconscious or has a seizure are provided for safety.
Legal Authority The form operates under the authority of the Education Act (R.S.O. 1990 c.E.2) to collect, use, and disclose personal information.
Information Use Information collected will be used for transportation arrangements and may be shared for health and safety reasons.

Guidelines on Utilizing Rcjtc F 02 02

Completing the Rcjtc F 02 02 form is an essential part of ensuring that student transportation needs are met, particularly when managing health-related information. Once the form is filled out, it can be submitted to the Renfrew County Joint Transportation Consortium for processing. Below are the steps to effectively complete the form.

  1. Personal Information: Start by writing the student's name at the top of the form.
  2. Teacher's Information: Enter the name of the student's classroom teacher in the designated area.
  3. Emergency Contacts: List the names of the parent/guardian and emergency contacts. Prioritize these contacts by numbering them (1, 2, 3).
  4. Signs and Symptoms: Check all applicable signs and symptoms that the student may experience, such as sweating or headaches. If necessary, specify any other symptoms not listed.
  5. Optimum Blood Sugar Level: Write down the optimum range of the student's blood sugar level. Be sure to provide this information accurately.
  6. Location for Sugar Treatment: Specify the location where sugar treatment will take place. You can indicate this under the appropriate section.
  7. Treatment Selection: Choose one treatment option provided by the parent from the list. Circle or mark your selection clearly.
  8. Follow-up Instructions: Note the follow-up steps if no improvement occurs after treatment, including whether to inform parents or call 9-1-1 if the situation is critical.
  9. Route Information: Record any pertinent route numbers and indicate whether this information is for the morning or afternoon.
  10. Submission: Make sure to submit the original form to the school and keep a copy for the Renfrew County Joint Transportation Consortium.

What You Should Know About This Form

What is the purpose of the RCJTC F 02 02 form?

The RCJTC F 02 02 form is used to collect important information regarding a student’s transportation needs and medical requirements. It helps ensure that the Renfrew County Joint Transportation Consortium can arrange safe and appropriate transportation for students, particularly in cases of health emergencies.

Who should fill out the RCJTC F 02 02 form?

The form should be filled out by a parent or guardian of the student. It is essential that the information provided is accurate, as it will be used to inform transportation providers about the student’s specific needs and any medical considerations that must be addressed during transport.

What information is required on the form?

The form requests various details including the student’s name, classroom teacher, and contact information for parents or guardians. Additionally, it includes a section to outline signs and symptoms of potential medical issues and the student's optimum level of blood sugar. The parent or guardian must also select a specific treatment option to be administered in case medical intervention is necessary.

What should be done if a student shows symptoms during transportation?

If a student shows symptoms of distress while being transported, the responsible adult should ensure the student is safe. In particular, if the student is unconscious, they should roll the student onto their side. It is crucial to call 9-1-1 if the student is unable to swallow or having a seizure. Parents or guardians should be informed immediately about any situation involving the student’s health during transport.

Is there a specific treatment that must be provided?

Yes, the form allows parents or guardians to choose one specific treatment option that can be provided in case of a health emergency. Options include fruit juice, sugar, regular pop, honey, or glucose tablets. It is important to specify this treatment, as it informs transportation personnel of the appropriate response in emergencies.

What should be done if the initial treatment does not improve the student’s condition?

If there is no improvement within 10-15 minutes of administering the chosen treatment, the same treatment should be repeated. Continuous monitoring is advised, and if the student remains unresponsive, emergency services should be contacted promptly.

How is the personal information on the form used?

The personal information provided on the RCJTC F 02 02 form is collected under the authority of the Education Act. It is utilized for arranging transportation and sharing necessary information with transportation providers to perform their duties. Additionally, the information may be used to address health and safety concerns, discipline issues, or legal matters as required.

Who can I contact for questions about the RCJTC F 02 02 form?

For any questions regarding the collection of information or the form itself, you can contact the General Manager of the Renfrew County Joint Transportation Consortium at 999 Cecelia Street, Pembroke. The telephone number is 613-732-8419.

Common mistakes

Filling out the RCJTC F 02 02 form can seem straightforward, but people often make errors that can lead to problems down the road. One common mistake is not prioritizing emergency contacts effectively. It’s essential to list contacts in a clear order, as this helps ensure that in an urgent situation, the right person is contacted first. When parents or guardians skip this step or fail to indicate the priority, it may delay crucial information reaching those who need to respond.

Another frequent error involves neglecting to provide detailed signs and symptoms. The form requests specific symptoms like “trembling” or “dizziness.” While it might be tempting to check off only a few boxes, offering as much detail as possible is important. This helps school staff better understand the child's condition and respond properly in an emergency. Lack of specificity can lead to confusion and insufficient care.

Many people forget to specify the location of sugar treatment. This section is vital. Without indicating where the treatment supplies are kept, school personnel may struggle to find them quickly when needed. Clear instructions about treatment supplies save time and help protect the student's health, especially during emergencies.

Finally, failing to select an appropriate treatment option can create challenges. The form lists several options, such as fruit juice or glucose tablets. Parents should carefully choose one that aligns with their child's specific health needs and preferences. Inadequate or unclear selections could lead to administering the wrong treatment in a critical moment, impacting the child's well-being.

Documents used along the form

The Rcjtc F 02 02 form is a key document used to manage student transportation needs, particularly for students with specific health concerns. It is often accompanied by a few other important forms and documents that facilitate effective communication and coordination. Below is a list of these other forms, along with short descriptions of their purposes.

  • Health Information Form: This form gathers relevant medical information about the student. It ensures that school staff are aware of any medical conditions or allergies that may affect the student's health during school hours.
  • Emergency Contact Form: Parents or guardians complete this form to provide contacts that can be reached in case of emergencies. It includes names and phone numbers in order of priority.
  • Transportation Agreement: This document outlines the terms of transportation provided to students. Parents or guardians sign this agreement to acknowledge the rules and responsibilities associated with student transportation.
  • Authorization for Release of Information: This form allows the sharing of the student’s medical information among relevant parties, including transportation providers and school staff, in accordance with privacy laws.
  • Individualized Education Plan (IEP): For students with special education needs, an IEP outlines specific accommodations and services. This plan helps to ensure that transportation is tailored to each student's unique requirements.
  • Incident Report Form: If there are any issues during transport, this form documents the incident for review. It helps ensure that safety concerns are addressed promptly.
  • Parental Consent Form: This form secures parental permission for various activities related to transportation, such as field trips. It confirms that parents are aware of and agree to their child's involvement.

Each of these documents plays a vital role in ensuring that student transportation is managed safely and effectively. By having the right forms in place, schools can better cater to the needs of every student, promoting a more supportive learning environment.

Similar forms

  • Emergency Contact Form: Similar in structure, this document collects essential contact information for emergencies, prioritizing contacts in a clear and concise manner.
  • Medical Release Form: This form serves to provide consent for medical treatment in emergencies, detailing necessary health information akin to the signs and symptoms section.
  • Health History Form: It gathers broader health information about a student, including allergies and existing conditions, paralleling the health details in the Rcjtc F 02 02.
  • Authorization for Transportation Form: This document establishes parental consent for transporting students, echoing the transportation oversight in the Rcjtc F 02 02.
  • Daily Medication Log: Similar in tracking health-related interventions, this log records medications administered during school hours.
  • Incident Report Form: Used to document accidents or injuries, this form, like the Rcjtc F 02 02, details actions taken and responsible individuals.
  • Permission Slip: This document requests permission for students to participate in specific activities, linking back to communication with parents about student safety.
  • Field Trip Form: Similar in nature, this form ensures that all necessary information and consent for off-site activities is collected efficiently.
  • Daily Attendance Sheet: This sheet monitors student presence, mirroring the need for organizational details similar to transportation schedules.
  • Medication Administration Record: It tracks dispensed medications to students, providing essential health management details that align with the care instructions in the Rcjtc F 02 02.

Dos and Don'ts

When filling out the Rcjtc F 02 02 form, attention to detail is essential. Follow these guidelines to ensure that the process is smooth and effective.

  • Do: Write clearly to ensure all information is easily read.
  • Do: Provide accurate contact information for the parent/guardian and emergency contacts.
  • Do: Specify any signs and symptoms the student may experience.
  • Do: Select a treatment option clearly from the choices provided.
  • Do: Inform staff of any specific health concerns related to the student.
  • Do: Review the form for completion before turning it in.
  • Do: Keep a copy for your records after submission.
  • Don't: Leave any sections blank; all required fields must be completed.
  • Don't: Use abbreviations that might confuse whoever reviews the form.
  • Don't: Forget to prioritize your emergency contacts in order of preference.
  • Don't: Provide outdated or incorrect information regarding the student's health.
  • Don't: Ignore instructions about treatments if a student is experiencing a serious reaction.
  • Don't: Submit the form without informing the responsible school officials of any urgent concerns.
  • Don't: Hesitate to ask questions if you are unsure about any section of the form.

Following these recommendations can help ensure the well-being of the student while facilitating effective communication with the school and transportation providers.

Misconceptions

Here are nine common misconceptions about the RCJTC F 02 02 form, along with clarifications:

  • Misconception 1: This form is only required for students with diabetes.
  • Clarification: The form is important for any student who may experience symptoms that require attention in a transportation setting.

  • Misconception 2: Parents do not need to fill out the contact section.
  • Clarification: Providing complete and prioritized emergency contacts is essential for timely communication in case of an emergency.

  • Misconception 3: The listed signs and symptoms are exhaustive.
  • Clarification: The symptoms listed are examples. Parents can specify any other signs relevant to their child’s health needs.

  • Misconception 4: There is only one acceptable treatment option for low blood sugar.
  • Clarification: Parents can choose from several treatment options based on their child's preferences and needs.

  • Misconception 5: The school has no responsibility for administering treatments.
  • Clarification: The form ensures that transportation staff are informed and prepared to act in accordance with the specified treatment plans.

  • Misconception 6: You do not need to update the form if changes occur.
  • Clarification: Any changes in emergency contacts or medical treatment preferences should be immediately communicated and updated on the form.

  • Misconception 7: The information on this form is not confidential.
  • Clarification: The information collected is protected under the Education Act and is only used for necessary purposes regarding transportation and safety.

  • Misconception 8: It is unnecessary to inform parents about actions taken in an emergency.
  • Clarification: Keeping parents informed is a key responsibility. They must know what actions were taken to ensure their child’s safety.

  • Misconception 9: The form can be discarded after submission.
  • Clarification: It is vital to retain a copy for school records to ensure continuity in care and updates as needed.

Key takeaways

When filling out the RCJTC F 02 02 form, keep these important points in mind:

  • Ensure you include the student’s name and the classroom teacher’s name clearly.
  • List parent/guardian and emergency contacts in the prioritized order for quick communication.
  • Identify any potential signs and symptoms the student may exhibit, such as sweating, dizziness, or extreme tiredness.
  • Specify the optimum level of blood sugar for the student, if known.
  • Select a treatment option provided by the parent, choosing from the listed options according to the student’s needs.
  • Detail the location of the sugar treatment and any relevant specifics.
  • If needed, follow the appropriate steps in an emergency, such as calling 9-1-1 for unconscious students.
  • Understand that personal information on the form is collected under the authority of the Education Act and is used solely for transportation and safety purposes.

Accuracy and thoroughness in completing the form can help ensure the safety and well-being of the student during transportation.