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SECTION 504 PLAN

FOR STUDENTS WITH PEANUT AND/OR TREE-NUT APPERGIES


(PTAs)

Student Name: Georgia Smith Birth Date: 03/14/11

Food Allergies: Peanut

School: Monsour Elementary School Grade: 2nd

Period Covered by Plan: One Year

Initial Evaluation Date: 09/12/18 Reevaluation Due Date: 09/11/19

1. Is the student disabled as defined by Section 504 of the Rehabilitation Act of 1973?
Yes
2. Describe the nature of the disabling condition. Doctor’s diagnosis of peanut and/or tree
nut allergies.
Symptoms: Georgia has a severe, airborne, peanut allergy. When is close proximity
to peanut residue, Georgia’s throat swells to the point of having a difficulty
breathing and speaking. Her face will become red and blotchy, and she often
clenches her throat.
3. Does the disability substantially limit a major life activity?
Yes
In which area?
While having a reaction, Georgia is unable to breath, speak, walk, or learn.

ACCOMMODATIONS

4. Ensure that this Plan is fully implemented and appropriately modified for the student.
5. Ensure all teachers and staff personal are trained in the use of Epi-Pens and are aware of
the warning signs of a peanut allergic reaction
6. Ensure that a school nurse or someone that can administer Georgia’s medications is on
site at all times during the school day, and is available for all school functions that
Georgia attends (including, but not limited to school dances, field trips, field days, picnic
lunches)
7. Ensure that Food Services is aware of the allergy and uses peanut substitutes in their
cooking. Ensure that all Food Service employees are aware of the allergy and know the
warning signs. Ensure that the Food Services
a. Read all products to ensure that they are peanut free
b. Monitor their recipes to ensure no peanut product
c. Plan menus that do not allow peanut contamination
d. Implement and monitor food handling procedures
e. Ensure the cleanliness of the entire cafeteria, by wiping down all tables and chairs
to limit the presence of peanut residue
f. Maintain the cleanliness of the kitchen and cleaning of all equipment to ensure
cross contamination does not occur
8. Ensure that all teachers and staff interacting with Georgia
a. Know Georgia’s allergies and her 504 Plan
b. Know the warning signs of a peanut reaction
c. Know the steps to take during an allergic reaction, and properly respond to the
situation
d. Know how to administer her medications: including antihistamines and
epinephrine
e. Attend a training for use of antihistamines and epi-pens
f. Demonstrate knowledge of Georgia’s plan
g. Utilize a folder of instruction and information for substitute use on Georgia’s
condition
9. Ensure access to all staff mentioned in item 8, access to the 504 plan
10. Ensure immediate parent notification after any allergic reaction
11. Develop a plan with student’s parents, physician, and school nurse to permit student to
carry their own medication (epi-pen)
12. In the event of a potentially life-threatening allergic reaction, ensure that the appropriate
emergency response team is called
13. Ensure that no food enters the classroom, including school lunches, snacks for holiday,
and birthday snack
14. Provide a list of substitute products that students may bring for classroom celebrations
15. Ensure a letter is sent home explaining the policy in Accommodation 13, describing the
classroom as a NO PEANUT ZONE
16. Ensure that all students and staff returning from lunch in 2nd grade thoroughly wash their
hands
17. Ensure that all classrooms for special thoroughly wipe down the desks and chairs before
Georgia’s class enters
18. Limit the number of peanut products in the cafeteria, and designate a peanut fee zone for
students with nut allergies
19. Ensure that the Cooking Classroom is a PEANUT FREE ZONE, and thoroughly cleans
the classroom after each class use
20. Keep copy of allergic reaction protocols in the cafeteria and cooking classroom
21. Keep epi-pens in the front office and the cafeteria office
22. Prohibit students and discipline them from exposing the student who has a peanut allergy
to peanut or harassing them due to their allergy
SECTION 504 PLAN
FOR STUDENTS WITH PEANUT AND/OR TREE-NUT APPERGIES
(PTAs)

Georgia Smith- Peanut Allergy

Signatures Titles

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