704 KAR 4:020. School health services.

704 KAR 4:020. School health services.

RELATES TO: KRS 156.160(1)(f), 161.145, 29 C.F.R. 1910.1030

STATUTORY AUTHORITY: KRS 156.070, 156.160(1), 214.034

NECESSITY, FUNCTION, AND CONFORMITY: KRS 156.160(1) requires the Kentucky Board of Education to adopt administrative regulations governing medical inspection, physical education and recreation, and other rules and administrative regulations deemed necessary or advisable for the protection of the physical welfare and safety of the public school children. This administrative regulation establishes standards and criteria for preventative health care examinations at the local school district level.

Section 1. School Employee Medical Examinations. (1) A local board of education shall require a medical examination of each certified and classified employee, including each substitute teacher, prior to initial employment that shall include a tuberculosis (TB) risk assessment.

(a) If the individual is identified by that assessment as being at high risk for TB, the individual shall be required to undergo the administration of a tuberculin skin test (TST).

(b) The TB risk assessment shall be performed and reported by a physician, an advanced registered nurse practitioner, a physician’s assistant, or a registered nurse.

(2) The medical examination requirement shall not apply to school bus drivers who are covered by 702 KAR 5:080.

(3) A local board of education may require by policy that a school employee physical examination be conducted no earlier than a ninety (90) day period prior to initial employment.

(4) A medical examination shall be reported on the form, "Medical Examination of School Employees".

(5) A person who tests positive for TB shall be required to comply with the directives of the local board of health and the Kentucky Department for Public Health for further evaluation and treatment of the tuberculosis infection.

(6)(a) Following the required medical examination for initial employment and any subsequent examinations as may be required for positive tuberculin reactors, a school district employee other than a bus driver shall submit to the local school superintendent a statement indicating the employee’s medical status.

(b) The medical examination shall be performed and signed for by a physician, physician assistant, or an advanced registered nurse practitioner.

(7) Documentation of a tuberculin skin test and chest x-ray, if performed, shall include:

(a) The date given;

(b) Type of test;

(d) Date read and by whom; and

(e) Date x-ray taken and results as related to tuberculosis status.

(8)(a)1. A local board of education shall require all school personnel exhibiting symptoms of chronic respiratory disease to undergo a tuberculosis (TB) risk assessment and examinations as indicated.

2. The evaluation and any recommended treatment for tuberculosis infection shall be based upon the directives of the local board of health and the Kentucky Department for Public Health.

(b) An employee exposed to infectious tuberculosis shall be tested and, if necessary, treated for tuberculosis infection according to the directives of the local board of health.

(c) In a county with an incidence of cases of active tuberculosis that is equal to or greater than the national average; as established by the Department for Public Health, Division of Epidemiology, Tuberculosis Control Program; the local board of health may, with the approval of the Kentucky Department for Public Health require more extensive testing of school district employees for tuberculosis.

Section 2. Preventative Health Care Examinations. (1)(a) A local board of education shall require a preventative health care examination of each child within one (1) year prior to the child's initial admission to school.

(b) A second examination shall be required within one (1) year prior to entry into the sixth grade.

(c) A third examination may be required by policy of the local board of education within one (1) year prior to entry into the ninth grade.

(2) An out-of-state transfer student shall be required to submit documentation of a preventative health care examination.

(3) A local school board may extend the deadline by which to obtain a preventative health care examination, not to exceed two (2) months.

(4) A preventative health care examination shall be performed and signed for by a physician, an advanced registered nurse practitioner, a physician's assistant, or by a health care provider in the early periodic screening diagnosis and treatment programs.

(5) A preventative health care examination shall be reported on the form Preventative Health Care Examination Form, and shall include:

(a) A medical history;

(b) An assessment of growth and development and general appearance;

(d) Recommendations to the school regarding health problems that may require special attention in classroom or physical education activities.

(6) A vision examination shall be reported on the form, Kentucky Eye Examination Form for School Entry.

(7) A record of immunization shall be submitted on an Immunization Certificate Form, EPID 230.

(8) A local school district shall establish a plan for implementation and compliance required for the sixth grade preventative health care examination.

(9) A valid Immunization Certificate Form, EPID 230, shall be on file within two (2) weeks of the child's enrollment in school.

(10)(a) A board of education shall adopt a program of continuous health supervision for all school enrollees.

(b) Supervision shall include scheduled, appropriate screening tests for vision, hearing, and scoliosis.

(11) A local spinal screening program for scoliosis, pursuant to subsection (10)(b) of this section, shall include:

(a) Training sessions for teachers or lay volunteers who will be doing the screening;

(b) Obtaining parental permission for scoliosis screening;

(c) Established screening times, at least in grades six (6) and eight (8) and appropriate procedures and referral criteria;

(d) Mandated education of students regarding scoliosis screening; and

(e) Required referral of all children with abnormal screening results for appropriate diagnosis and treatment and follow-up on these referrals. Local referral and follow-up procedures shall include:

1. Notification of parents of students who need further evaluation by a physician;

2. Tracking referrals to determine whether all children with abnormal screening results receive appropriate diagnosis and treatment; and

3. Reporting of data on screening, referral, and follow-up tracking to the Department of Education.

(12) The Department of Education shall:

(a) Monitor the spinal screening and referral programs provided by local boards of education;

(b) Provide consultation and technical assistance to local school districts concerning spinal screening, referral, and follow-up for appropriate diagnosis and treatment; and

(c) Encourage local school districts to work cooperatively with local health departments and local Commission for Children with Special Health Care Needs offices to plan, promote, and implement scoliosis screening programs.

(13) Referral and appropriate follow-up of any abnormality noted by a screening assessment or teacher observation shall be recorded on school health records.

(14) A school shall have emergency care procedures, which shall include:

(a) First aid facilities, including provisions for designated areas for the child to recline;

(b) A requirement that whenever children are present during school hours, there shall be at least one (1) adult present in the schools who is certified in a standard first aid course which includes CPR for infants and children;

(d) The name of the family physician; and

(e) A name of family physician

(15) A local board of education shall require immunizations as required by KRS 214.034.

Section 3. Cumulative Health Records. (1) A school shall initiate a cumulative health record for each pupil entering its school.

(a) The record shall be maintained throughout the pupil's attendance.

(b) The record shall be uniform and shall be on the form "Pupil's Cumulative Health Record".

(c) The record shall include screening tests related to growth and development, vision, hearing, and scoliosis, and findings and recommendations of a physician and a dentist.

(d) A follow-up by the proper health or school authorities shall be made on each abnormality noted, and the result shall be recorded.

(2) A local school authority shall report all known or suspected cases of communicable disease immediately to the local health department.

Section 4. Physical Environment. (1) A board of education shall provide and maintain a physical environment that is conducive to the health and safety of school children in each school under its jurisdiction.

(2) A local board of education shall comply with current laws and administrative regulations applicable to all public buildings pertinent to health, sanitation, and safety.

(3) A local board of education shall establish:

(a) An adequate supply of water of safe, potable, sanitary quality;

(b) A state-approved sanitary disposal of sewage, other water carried waste, and solid waste;

(c) Adequate toilet and lavatory facilities, including soap or detergent as well as towels or other methods for drying hands, and other sanitary fixtures;

(d) Adequate heating, lighting, and ventilation in all school buildings;

(e) Adequate facilities and equipment for cafeterias and lunchrooms;

(f) Supervision of general sanitation and safety of the school buildings, grounds, and playground equipment;

(g) Adequate first aid facilities;

(h) Adequate control of air pollutants; and

(i) Universal precautions guidelines compatible with Occupational Safety and Health Administration requirements established in 803 KAR 2:320; and 29 C.F.R. 1910.1030.

Section 5. A superintendent shall designate a person to serve as school district health coordinator.

(1) The person designated shall meet the minimum qualifications required of this position as determined by the Educational Professional Standards Board in 16 KAR 4:010 or by the Kentucky Department of Education in the Local District Classification Plan for, Class Code: 7271.

(2) Class Title: School District Health Coordinator. The school district health coordinator shall work in cooperation with all school personnel, the local board of education, the State Department of Education, the local health department, family resource and youth services centers, and parents in planning, promoting, and implementing a school health services program.

Section 6. Incorporation by Reference. (1) The following material is incorporated by reference:

(a) "Medical Examination of School Employees", October 2007;

(b) "Preventative Health Care Examination Form", December 1999;

(d) " Local District Classification Plan ", "Class Code: 7271, Class Title: Local District Health Coordinator", December 1999;

(e) "Kentucky Eye Examination Form for School Entry", August 2000; and

(f) "Immunization Certificate Form", EPID 230, October 2007.

(2) This material may be inspected, copied, or obtained, subject to applicable copyright law, at the Division of Nutrition and Health Services, Department of Education, 2545 Lawrenceburg Road, Frankfort, Kentucky 40601, Monday through Friday, 8 a.m. to 4:30 p.m. (SBE 48.011; 1 Ky.R. 81; eff. 11-13-74; Am. 5 Ky.R. 1086; eff. 8-1-79; 7 Ky.R. 28; eff. 9-3-80; 8 Ky.R. 1162; 9 Ky.R. 114; eff. 6-22-82; 1315; eff. 7-6-83; 17 Ky.R. 2245; eff. 3-13-91; 18 Ky.R. 1202; 2256; eff. 1-10-92; 19 Ky.R. 2494; 20 Ky.R. 75; 509; eff. 8-5-93; 26 Ky.R. 1449; eff. 3-10-2000; 27 Ky.R. 1332; eff. 1-15-2001; 34 Ky.R. 628; 1421; eff. 1-4-2008.)