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Anaphylaxis Emergency Plan

An anaphylaxis emergency plan is vital to share with teachers and caregivers. It lists a person’s allergies, the signs and symptoms to watch for, and the emergency procedure to follow.

Close-up of Emergency document with pencil

Forms for schools and caregivers: Anaphylaxis Emergency Plan

An anaphylaxis emergency plan lists a person’s allergies, the signs and symptoms to watch for, and the emergency procedure to follow in case of a reaction. It’s important to share this form with your child’s school and caregivers, and to review it with your child, depending on their age.

Anaphylaxis Emergency Plan with EpiPen® instructions

Anaphylaxis Emergency Plan with ALLERJECT® instructions

Anaphylaxis Emergency Plan with EpiPen® and ALLERJECT® instructions

These documents are accessible versions/AODA compliant.
Quick Facts
  • The Anaphylaxis Emergency Plan is a fillable form. You can download, fill in, and save your information OR print a copy and add your information by hand.
  • If you are using it as a fillable form, remember to download and save the file first before entering information. Do not complete the form within your browser as information will not be saved.
  • You can use Adobe Acrobat to add an image (.jpeg, .png, etc.) or Adobe Acrobat Reader to add an image (.pdf only) to the “PHOTO” box of the Anaphylaxis Emergency Plan. To do so, please follow the instructions related to the Adobe software version you are using. Alternatively, you can print the completed form and attach a photo to this box.
  • Note: The current version of the Anaphylaxis Emergency Plan is dated May 2020. It is an updated version of the August 2016 plan included in the resource Anaphylaxis in Schools & Other Settings, the national guidelines for anaphylaxis management in Canadian schools.