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YOUTH PROGRAM OBSERVATION REPORT 

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Logistics

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YPP Representative
Observation Date
Logistics Information
Contact Information
Check-In Process for visit:
Required Documentation

Please indicate if the following documents are on site and easily accessible. The documents are all required under University of Texas at El Paso Handbook of Operations, Section 1 Chapter 5.
Required Release and Form Accessibility (Provision 5.3.4.8)

Notes:
Required Release and Form Accessibility (Provision 5.3.4.8) 
Required Release and Form Accessibility (Provision 5.3.4.8) 
Youth Protection Training Certificates Accessibility (Provision 5.3.4.3)
Texas Department of State Health Services form submitted prior to camp, if applicable (Provision 5.3.4.3)

Notes:
Youth Protection Training Certificates Accessibility (Provision 5.3.4.3)
Texas Department of State Health Services form submitted prior to camp, if applicable (Provision 5.3.4.3)
Youth Protection Training Certificates Accessibility (Provision 5.3.4.3)Texas Department of State Health Services form submitted prior to camp, if applicable (Provision 5.3.4.3)
Medical Treatment Forms Accessibility (Provision 5.3.4.10)

Notes:
Medical Treatment Forms Accessibility (Provision 5.3.4.10)
Medical Treatment Forms Accessibility (Provision 5.3.4.10)
Background Check Verifications Accessibility (Provision 5.3.4.1)

Verified that the Designated Individuals were background checked:
Background Check Verifications Accessibility (Provision 5.3.4.1)

Verified that the Designated Individuals were background checked:
Background Check Verifications Accessibility (Provision 5.3.4.1) Verified that the Designated Individuals were background checked:
Program Operations
Day or overnight Youth program:
Supervision ratio observed (Provision 5.3.2)
Age range of participants
When does staff receive emergency protocol training?
How does staff communicate emergency protocol? What is the protocol? (Provision 5.3.4.9)
Risk Management
Communication among staff:
Directional markers throughout Youth program activities:
Identification among staff, counselors, and participants:
Outside influences during Youth program?
Event Strengths, Challenges, Opportunities and Threats (SCOT) Analysis
Strengths of the event:
Challenges of the event:
Opportunities for future events:
Activities observed during observation:
Additional Notes from Observation:
MEDICATION MANAGEMENT

Does the Youth program have a qualified medical professional on-site to: • administer prescription drugs only under the specific directions of a licensed physician • administer non-prescription drugs under the signed instruction of the parent or physician • provide health care support for reasonably anticipated illness or injuries • maintain all medications in a locked and secured location
MEDICATION MANAGEMENTDoes the Youth program have a qualified medical professional on-site to: • administer prescription drugs only under the specific directions of a licensed physician • administer non-prescription drugs under the signed instruction of the parent or physician • provide health care support for reasonably anticipated illness or injuries • maintain all medications in a locked and secured location
HEALTH HISTORY

Does the Youth program receive a current signed health history from each minor participant, requesting all the following information:
  • parent/guardian contact information
  • past medical treatment, if any
  • allergies and/or dietary restrictions
  • immunizations including date of last tetanus shot
  • current medications
  • description of any current physical, mental or psychological conditions requiring medication, treatment or activity restrictions
HEALTH HISTORYDoes the Youth program receive a current signed health history from each minor participant, requesting all the following information:parent/guardian contact informationpast medical treatment, if anyallergies and/or dietary restrictionsimmunizations including date of last tetanus shotcurrent medicationsdescription of any current physical, mental or psychological conditions requiring medication, treatment or activity restrictions
SPECIAL HEALTH NEEDS

In order to meet special needs of participants, does the Youth program have the following resources available:
  • a system for evaluating the program’s ability to meet the needs of minor participants with special needs
  • information regarding health management practices available to consumers for education on the program’s approach to special health needs
  • alert staff about Youth participants with special medical needs
SPECIAL HEALTH NEEDSIn order to meet special needs of participants, does the Youth program have the following resources available:a system for evaluating the program’s ability to meet the needs of minor participants with special needsinformation regarding health management practices available to consumers for education on the program’s approach to special health needsalert staff about Youth participants with special medical needs
MEDICAL LOG

Does the Youth program have a bound medical log or record keeping system that list the participant’s name, listing date, camp health officer, and treatment prescribed?
MEDICAL LOGDoes the Youth program have a bound medical log or record keeping system that list the participant’s name, listing date, camp health officer, and treatment prescribed?
INCIDENT REPORTING

Are these incidents (including minor to major physical injuries, behavioral issues, over-the-counter medication disbursement) submitted to Office of Youth Program Development and Support within 24 hours of the incident?
INCIDENT REPORTINGAre these incidents (including minor to major physical injuries, behavioral issues, over-the-counter medication disbursement) submitted to Office of Youth Program Development and Support within 24 hours of the incident?
EMERGENCY TRANSPORTATION

Does the program have a procedure for emergency transportation available by the Youth program or community services
EMERGENCY TRANSPORTATIONDoes the program have a procedure for emergency transportation available by the Youth program or community services
 UTS 192 Youth Protection Policy | The University of Texas System
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