Download sample forms, checklists, and other materials to facilitate your schoolwide screening program.
We are grateful to La Clínica de La Raza and Native American Health Center for providing these samples.
Age-based guidance for what to screenDownload PDF
Sample workplan for implementing schoolwide screeningsDownload PDF
Roles & Responsibilities
List of staff roles and responsibilitiesDownload PDF
For screening adolescent studentsDownload Word Document
For outreach to studentsDownload PDF
For school-based oral healthDownload Word Document
For notifying parents of resultsDownload Word Document
For parental denial of consent to treatmentDownload Word Document
Step-by-step screening processDownload Word Document
This information is adapted from the Population-Wide Screenings in Schools Guide: A publication of UCSF and Family Health Together. We are grateful to our partners at ETR for funding and the UCSF School of Nursing for creating this content: Naomi Schapiro, RN, PhD, CPNP; Emily Green, RN, PhD; Victoria F. Keeton, PhD, RN, CPNP-PC; and Ivette Gutierrez, M.A.
We would also like to acknowledge Alameda County Center for Healthy Schools and Communities, Oakland Unified School District, La Clínica de la Raza, Native American Health Center, Lifelong Medical, Karen Gersten-Rothenberg, and Joanna Bauer for their contributions to this toolkit.