We hope that the information provided in the Resources and FAQ pages have been helpful to you. If you still have questions about your program or activity, please email:

programsforminors@uga.edu

or you may call Brian Stone at 706-542-7255.

Mandatory Reporting of Child Abuse

 

The University of Georgia is committed to the safety and well-being of children and the prompt reporting of suspected child abuse or neglect. These instructions outline reporting procedures for University employees and volunteers in accordance with Georgia Law (O.C.G.A. §19-7-5) and University policies for the protection of minors.

Reporting Requirements

All University employees and volunteers acting in the scope of their employment who have reasonable cause to believe that child abuse has occurred shall immediately (but in no case later than 24 hours) make a report or confirm that a report has been made to ALL of the following:

1) The UGA Police Department (UGAPD) at 706-542-2200 or 911 (emergency);

2) Their Supervisor, Program Director, or other responsible University official; AND

3) The Georgia Division of Family and Children Services (DFCS) at 1-855-GACHILD.

If you have reasonable cause to believe child abuse has occurred, DO NOT attempt to investigate the matter further or gather additional information before reporting.

Definitions

Child/Minor: any person under the age of 18.

Child Abuse: non-accidental physical injury, neglect, exploitation, sexual abuse, or sexual exploitation.

University Follow-up

Upon receipt of a report, the UGAPD will investigate any suspected child abuse on campus or involving a University employee or volunteer and will follow up with DFCS, as necessary.

University Supervisors, Program Directors, and officials will take immediate action in order to protect the minor, to encourage employee or volunteer compliance with the directives herein, and to work with the UGAPD during any investigation that results from the report.

Failure to Report

Failure of Mandatory Reporters, as defined by O.C.G.A. §19-7-5, to report suspected child abuse is a violation of state law and may subject the individual to criminal penalties.

Failure of University employees or volunteers to comply with the directives herein may result in disciplinary action, up to and including termination from employment or volunteer service.

Non-Retaliation

The University prohibits any employee, student, or volunteer from retaliating or taking any adverse action against another employee, student, or volunteer for reporting a reasonable suspicion of sexual or physical abuse or neglect of a minor. If an individual believes he or she is being retaliated against, the individual should contact his or her supervisor or Human Resources.

The State of Georgia grants immunity from any civil or criminal liability for the making of a report, in good faith, of suspected abuse of a minor.

Professional License Requirements

Professional licensing associations may require additional reporting requirements for certain professions (e.g., teachers, social workers, child care providers). University employees, volunteers, and students holding such designations are encouraged to consult their professional licensing associations for more information.

University Students

University Students employed by or volunteering on behalf of the University who have reasonable cause to believe that child abuse has occurred shall follow the Reporting Requirements listed above.

University Students at a field placement, on-site course, research project, outreach project, or other event supervised by an agency with which the University cooperates (e.g., schools, community agencies, medical facilities, internship sites) who have reasonable cause to believe that child abuse has occurred must notify the organization’s lead administrator or other designated official (e.g., school principal, counselor, facility director) immediately, and subsequently notify their University Supervisor or Program Director, who is subject to the Reporting Requirements listed above.

University Students operating under the supervision and professional license of a University Supervisor or Program Director (e.g. psychologist, speech language pathologist, social worker) who have reasonable cause to believe that child abuse has occurred must notify their supervisor immediately, and subsequently the student and the University Supervisor or Program Director will follow the Reporting Requirements listed above.

Programs and Activities for Minors

Additional University resources, including access to a free online training module, are available at: https://programsforminors.uga.edu/

UNIVERSITY OF GEORGIA

POLICY FOR PROGRAMS AND ACTIVITIES SERVING MINORS

The University of Georgia is committed to providing a safe and healthy environment for all who participate in programs and activities on campus or otherwise affiliated with the University. There are a variety of opportunities available for minor children, including academic camps, athletic camps, clinics, research, after-school programs, work or activities under the supervision of an individual faculty member, enrichment classes, and other activities. These programs and activities are integral to the University’s mission as a land-grant and sea-grant institution and provide a benefit to both the University and the larger community. This Policy recognizes the special duty of care and supervision when working with minors and sets forth operational requirements to enhance the protection of minors.

I. Definitions

Mandatory Reporter:  Any person who is required by Georgia law (O.C.G.A. §19-7-5) to report suspected child abuse to the appropriate authorities. Mandatory Reporters include but are not limited to faculty/teachers, administrators, counselors, social workers, psychologists, law enforcement personnel, and other persons who participate in providing care, treatment, education, training, supervision, coaching, counseling, recreational programs, or shelter to Minors.

Minor: Any person under 18 years of age (O.C.G.A. §39-1-1).

Program/Activity: Any academic, admissions, athletic, educational, research, service, leadership, or recreational program serving one or more Minors, including, but not limited to, camps, clinics, conferences, workshops, tutoring, mentoring, group lessons, seminars, competitions, internships or experiential learning, conducting or viewing research, pre-enrollment visits, after-school programs, or other enrichment opportunities.

Program/Activity Administrator: Any individual who has primary and direct operational responsibility for the overall content and execution of a Program/Activity and who serves as the primary point of contact.  

Program/Activity Staff: Individuals, whether paid, volunteer, or for academic credit, who have care, custody, control, and/or direct contact or interaction with Minors involved in Programs/Activities. This includes, but is not limited to, University administrators, faculty, staff, students, volunteers, and third parties when operating a Program/Activity.

Third Party: An individual, organization, or entity external to the University, to which the University allows use of its facilities to operate a Program/Activity.

Sponsoring Unit: Any department or unit of the University that offers a Program/Activity. 

University Facility: A building, structure, classroom, research or teaching laboratory, outdoor area, grounds, or athletic venue owned, leased, or controlled by the University, or used in connection with any Program/Activity.

II. Applicability 

This Policy applies broadly to all Programs/Activities serving one or more Minors, including those:

1. Offered by departments or units of the University at a University Facility or sponsored by the University at other locations;
2. Offered by the University’s registered student organizations at a University Facility or sponsored by University registered student organizations at other locations; or
3. Offered by Third Parties utilizing a University Facility.

This Policy does not apply to:

1. Programs/Activities for Minors enrolled in undergraduate or graduate academic coursework;
2. Events or visits to campus where Minors are supervised by their parent/guardian;
3. Events at the University that are open to the general public or invited guests where parents/guardians are expected to provide supervision of Minors;
4. Minor employees; and
5. University of Georgia employees or students hosting family members, friends, or other guests.

This Policy shall supplement, not replace, any existing safety and security measures, policies, or codes of conduct currently in place or hereinafter enacted. 

III. Requirements

This Policy provides minimum operational requirements for Programs/Activities involving Minors. Recognizing that all Programs/Activities are unique as to subject matter and risk, each Program/Activity Administrator, Sponsoring Unit, or Third Party must evaluate the nature of the Program/Activity and take appropriate actions to ensure the safety and security of all individuals involved and to ensure compliance with all applicable laws, regulations, and policies.

(A) Review and Approval

The following considerations should be addressed by the Program/Activity Administrator in advance of the Program/Activity:

1. Alignment of the Program/Activity with the University’s mission;
2. Appropriate subject matter and fully planned activity itinerary;
3. Appropriate staffing and supervision ratios, with special regard to avoiding one-on-one contact between Minors and Program/Activity Staff;
4. Program/Activity Staff Code of Conduct and guidelines;
5. Appropriate training for Program/Activity Staff;
6. Minor Code of Conduct, Applicable Forms, Waivers, and any supplemental Program/Activity guidelines;
7. Program/Activity orientation and information for Minors and parents;
8. For Minors working in University laboratories, follow the UGA Policy on Minors (not Acting as Students/Employees) in Research Laboratories, Clinics, and Animal Facilities;
9. Transportation arrangements;
10. Housing arrangements with special consideration for overnight Programs/Activities;
11. Contracts for Auxiliary Services and Food Services;
12. Safety and security planning including, but not limited to:
    1. Basic first aid;
    2. Emergency response and notification plans;
    3. Reporting protocols for injury and/or illness; and
    4. Inclement weather plans;
13. Response protocols for accusations of misconduct;
14. Insurance;
15. Any licensing or exemption required by a government agency; and
16. Record retention policies.

All University Programs/Activities must be approved by the Sponsoring Unit’s Dean, Director, Vice-President, or Department Head, as applicable. Programs/Activities operated by Third Parties must certify compliance with this Policy to receive approval for facility use.

(B) Program/Activity Registration

After review and approval, the Program/Activity must be registered. To register a Program/Activity, visit:  programsforminors.uga.edu.

Programs/Activities must be registered within sufficient time to meet the requirements of this Policy, which is normally not fewer than 60 days before the Program/Activity’s start date. Programs/Activities must be registered annually.

(C) Background Investigation and Screening

All University Program/Activity Staff who have direct contact with Minors are required to undergo a criminal background check (including sex offender registry check) in accordance with the Human Resources Administrative Practice Manual (HRAP). Program/Activity Administrators must ensure that all Program/Activity Staff, including University employees, University students, and volunteers, who have direct contact with Minors have a curent background check that meets HRAP requirements prior to working with Minors. Program Adminstrators should coordinate with their unit's HR office or University HR to confirm the background check status of all Program/Activity Staff.   

Third Parties must certify that all Program/Activity Staff have undergone background checks, which would, at a minimum, satisfy the HRAP requirements.

Program/Activity Administrators must be in receipt of background check clearance on all Program/Activity Staff prior to involvement.

Program/Activity Staff must self-report any arrest, charge, or criminal conviction occurring after the date of the background check to their Program/Activity Administrator, prior to returning to a Program/Activity. Additionally, all University employees are subject to the Policy on Arrest and Criminal Charges and must complete an Arrest and Conviction Self-Disclosure Form.

Depending on the nature of the Program/Activity, additional screening of Program/Activity Staff beyond background checks may be advisable, including in-person interviews and/or reference checks.

(D) Training

All Program/Activity Staff must be trained on their responsibilities or issues related to Minor health, safety, and security. Training documentation and certifications should be maintained by the Program/Activity Administrator. Required training should at a minimum be completed every two years.

All Program/Activity Staff and all Program/Activity Approving Officials must receive training on the following:

1. Mandatory Reporting obligations, including child abuse awareness and prevention;
2. The University’s Non-Discrimination and Anti-Harassment Policy and the Board of Regents Sexual Misconduct Policy; and
3. Code of Conduct for Program/Activity Staff.

Additionally, training appropriate to the specific Program/Activity as developed by the Program/Activity Administrator must be also provided on the following:

1. Code of Conduct for Minor participants;
2. Reporting requirements during the Program/Activity, processes, and contacts;
3. Disability accommodations and review and evaluation of special requests;
4. Safety and security protocols;
5. First aid guidelines and medication management; and
6. Activities, risks, and responsibilities of the Program/Activity, as applicable.

(E) Records Retention

All records should be retained in accordance with Board of Regents policies on record retention. Copies of all required forms and documentation pertaining to Minors should be retained for a period of three (3) years after the Minor reaches the age of eighteen (18). Records pertaining to Program/Activity Staff should be retained for five (5) years.  

IV. Conduct

The University requires the highest standards of conduct when interacting with Minors, including compliance with all applicable laws, regulations, and policies.  

1. Code of Conduct: All Minor participants and Program/Activity Staff must agree to abide by the applicable Code of Conduct, as well as any supplemental Program/Activity guidelines developed by the Program/Activity Administrator.
2. Requirements for Minor participants: Parents/guardians must submit required forms before Minors will be allowed to participate in Programs/Activities.  These forms may include, but are not limited to, a participation agreement form, authorization to administer medication, pick-up authorization, medical information and authorization, release of claims/waiver of liability, media/photo/video release, and Minor participant’s Code of Conduct.

V. Third Party Use of a University Facility

In order to utilize University Facilities for Programs/Activities, Third Parties must execute a Facilities Use Agreement. Use for a Program/Activity requires compliance with this Policy, including being approved by a UGA Sponsoring Unit, certifying criminal background checks, and ensuring proper training for all Program/Activity Staff. Please contact the Office of Real Estate in the Office of Finance and Administration for an approved Facility Use Agreement.

VI. Reporting

1. Injury: In order to maintain a safe environment for all students, faculty, staff, and visitors, it is important that the University be informed, at the earliest possible date, of any injuries that occur at a University Facility or to faculty and staff in the course of their work responsibilities. Please report all injuries via the online reporting form through Finance and Administration.
2. Child Abuse/Mandatory Reporters: All Program/Activity Staff, including volunteers and Mandatory Reporters who have reasonable cause to believe that suspected child abuse has occurred, shall immediately report the suspected abuse to ALL of the following:

(1) The UGA Police Department at 706-542-2200 or 911(emergency);

(2) The Program/Activity Administrator, Supervisor, or other responsible University Official; AND

(3) The Georgia Division of Family and Children Services at 1-855-GACHILD.

Do not attempt to investigate a matter further or gather additional information before reporting.

A Mandatory Reporter must ensure that the Division of Family and Children Services is notified of the suspected abuse immediately and in no case later than 24 hours after the Program/Activity Staff (or other reporter) first had reasonable cause to suspect the abuse.

By doing so, you are not necessarily making an accusation; you are merely reporting facts for trained professionals to evaluate and investigate.

For more information on Mandatory Reporting of Child Abuse, see https://legal.uga.edu/policies/child_abuse_reporting/.

VII. Accountability

1. Site Visits: The Director of Compliance will conduct random site visits of Programs/Activities to ensure compliance with the Policy and to encourage use of best practices when dealing with Minors. Following the visit, the Director of Compliance will provide feedback to programs on areas of recommended improvement.
2. Violations and Sanctions: Violators of this Policy will be held accountable for their actions under the Program/Activity’s Code of Conduct, University policy, and applicable law. Sanctions for violations may include, but are not limited to, suspension of University funding, non-renewal or termination of the Program/Activity, suspension, dismissal, or termination of University employment or Program/Activity Staff status, or removal or barring from University Facilities.
3. University Funding: University Programs/Activities that are not approved and registered pursuant to this Policy will not be eligible for payment, repayment, or reimbursement by University Business & Accounting Services.

VIII. Policy Implementation

This Policy is adopted in accordance with Board of Regents Policy 6.9, Programs Serving Minors.

IX. Policy Responsibility

Responsible University Senior Administrator:  Vice President for Public Service and Outreach

Responsible University Administrator:  Director, Georgia Center for Continuing Education & Hotel

Policy Owner:  Director of Compliance, Programs and Activities Serving Minors

Policy Contact:  programsforminors@uga.edu

Phone Number:  706-542-7255

The Director of Compliance will enhance compliance with the Policy by Program Administrators and Approving Officials; create additional training and engagement opportunities relating to the Policy; institute record retention systems for documenting compliance; improve the online registration and approval process; assess departmental/program compliance; and ensure that the University is engaging in best practices when dealing with Minors.

Because the protection of Minors is a University-wide concern, a key group of administrators will be charged by the President to serve on a committee to review and address issues arising under this Policy. The committee will consist of four to six administrators selected from the following units:  Academic Affairs, Athletics, University Human Resources, Public Service and Outreach, Student Affairs, and 4-H. 

The committee is empowered to take steps necessary to promote the safety of Minors while at the University and for University Programs/Activities held elsewhere, including: 

1. Recommending changes to this Policy;
2. Recommending appropriate actions for Program/Activity Administrators, Departments, and Units in accordance with applicable University policies and procedures;
3. Initiating enforcement actions against an individual or Program/Activity; and
4. Any other action reasonably required in furtherance of this Policy.  

X. Forms and Resources

Sample Forms, Program/Activity Checklists, and additional resources are available at programsforminors.uga.edu/documents.

Policy History

Adopted by University Cabinet April 26, 2017

Amended:  February 10, 2021

Amended:  October 7, 2024

Background Investigations and Screening

All Program/Activity Staff, including employees, University students, and volunteers, who will have direct contact with minors must undergo background investigations (including sex offender registry check) in accordance with the Human Resources Administrative Practice Manual (HRAP).

Pursuant to record retention requirements under the Policy, Program Administrators shall maintain in their Program/Activity files a verification the background investigation was performed for all Program/Activity Staff.

Program Administrators should submit a list of all Program/Activity Staff, regardless of UGA employment status, to Human Resources prior to start of Programs/Activities to ensure background investigations are completed as required by HRAP.

UGA Program/Activity Background Investigation Process:

1.  Background checks are subject to the University of Georgia Background Investigation policy. All University employees who will have direct contact with minors must be in accordance with HRAP Background Investigation requirements prior to working with minors. All University students and volunteers working with a UGA minors Program/Activity must also complete a Background Investigation. If the Program/Activity is sponsored by UGA, University student and volunteer Background Investigations will be handled by UGA HR.

2.  Download and complete the UGA Consent for Background Investigation form.

3.  Submit your completed background form through your unit's HR Business Representative. If you do not know your unit's HR rep you can find your HR rep here or contact the Director of Compliance at programsforminors@uga.edu for assistance.

4.   Allow at least fourteen days for background investigations to be completed.

5.  If you have questions or need assistance with this process, contact UGA Human Resources by calling 706-542-2222.

Third Party Program/Activity Background Investigation:

The University of Georgia Human Resources Office does not conduct Background Investigations on third party Programs/Activities. Third parties working with minors using UGA facilities must ensure all of their Program/Activity Staff, including volunteers, are background checked in compliance with the Policy. As a condition of utilizing University facilities, third parties are required to certify that they have performed background checks on Program/Activity Staff which would, at a minimum, satisfy HRAP requirements.

Background investigations shall include, at a minimum, the following checks:

• A state and federal criminal history check covering a minimum of seven (7) years.
• A nationwide sex offender search.
• A social security number check using the Form I-9 and the federal E-Verify system.
• For positions that will have access to financial resources such as handling money, checks, purchasing cards, etc., a financial credit check is also required.

If any third party organizations have questions about the background check requirements, please contact:

                Talent Escalated Background team, University Human Resources, hrweb@uga.edu, 706-542-2222

The University of Georgia offers numerous programs and activities for non-student minors including camps, clinics, after-school programs, enrichment activities, mentoring, and research opportunities. Programs and activities may be University-sponsored or held by third parties in University facilities. These programs and activities benefit both the University and the larger community, and are integral to the University’s mission as a land-grant and sea-grant institution.

The safety and well-being of visitors to our campuses is of the highest concern. The University of Georgia is committed to best practices that will provide a safe and healthy environment for all who participate, volunteer, or work in minor programs and activities. The Policy for Programs and Activities Serving Minors updates current guidelines and procedures and aligns with Board of Regents Policy 6.9.

This site is designed to serve as resource on the Policy for members of the University community and those responsible for coordinating minor programs and activities.

Important:  The UGA protection of minors training required for all staff has moved to PEP from eLC. Any UGA employee or student who needs to complete this training can access it here:  UGA Protection of Minors Training. Staff should provide their completion certificate to their Program Administrator for proof of completion and records retention purposes. Third party and any other non-UGA affiliated staff can access the training in eLC. For assistance for non-UGA staff contact the Director of Compliance at programsforminors@uga.edu. 

Important:  Two resources have been created to provide safety of minors guidance to program leaders and staff. The Missing Minors Guide provides instruction on how to correctly handle the situation if a minor is missing from where they should be. The Youth Mental Health Support Guide provides guidance on supporting a minor who is having a mental health issue. Program leaders should review and use these guides as needed to support their minor participants.

Important:  A Guide for Best Practices has been created. This guide is designed for minors program leaders and their staff to provide information on several key planning and operational areas including Medical and First Aid, Safety and Security, and Residential Programs. The Guide is available here:  Best Practices Guide.

Training Opportunities:  

Policy Overview Training:  There will be an online Learning and Development session entitled "Protecting Minors on Campus: An Overview of the University Policy and Best Practices for Safe Programs," Wednesday, September 9th at 2:00pm. Register here: UGA Protection of Minors Overview.  

An ancillary policy for minors protection has been implemented.  The Policy on Minors (not Acting as Students/Employees) in Research Laboratories, Clinics, and Animal Facilities aims to ensure the safety and security of minors by designating when they will be allowed to perform research in University laboratories, greenhouses, clinic areas, or animal facilities.  All employees who work with minors in laboratory settings need to review and follow this policy.

 

University Protection of Minors Training for All Supervising Staff:  All adult staff who will supervise minors in UGA Program/Activity must complete required training. While this training can be completed in other ways the recommended method is to complete the University's training modules housed in PEP:  UGA Protection of Minors Training. Staff should provide their completion certificate to their Program Administrator for proof of completion and records retention purposes.Third party and any other non-UGA affiliated staff can access the training in eLC. For assistance for non-UGA staff contact the Director of Compliance at programsforminors@uga.edu.

Training Overview:

All program staff, including volunteers, who will have direct contact with minors and all Program/Activity Approving Officials must undergo three required trainings on 1) their role as a mandatory reporter, 2) the University’s Non-Discrimination and Anti-Harassment Policy and the Board of Regents Sexual Misconduct Policy, and 3) completion of a Staff Code of Conduct.  Required training should at a minimum be completed every two years.

Additionally, Program Administrators are responsible for developing program-specific trainings at a level appropriate to the program/activity; program-specific training should cover safety and security protocols to include emergency procedure response, first aid guidelies and medication management, behavior management and discipline, accountability and supervision, notification and reporting requirements, and activities, risks, and responsibilities of the program and staff responsibilities. 

Minors in Labs:  An ancillary policy for minors protection has been implemented.  The Policy on Minors (not Acting as Students/Employees) in Research Laboratories, Clinics, and Animal Facilities aims to ensure the safety and security of minors by designating when they will be allowed to perform research in University laboratories, greenhouses, clinic areas, or animal facilities.  All employees who work with minors in laboratory settings need to review and follow this policy.

Training Opportunities:

The Director of Compliance is available to provide training sessions on the policy to university units. If you would like to schedule a training on the policy, contact us at programsforminors@uga.edu.

Policy Overview Training:  There will be an online Learning and Development session entitled "Protecting Minors on Campus: An Overview of the University Policy and Best Practices for Safe Programs," Wednesday, September 9th at 2:00pm. Register here: UGA Protection of Minors Overview.  

Online Resources to Complete Required Training:

Training may be accomplished through a variety of methods, including in person training or via the online trainings. 

Online trainings for Mandatory Reporting, the University’s Non-Discrimination and Anti-Harassment Policy and the Board of Regents Sexual Misconduct Policy, and the UGA Staff Code of Conduct for UGA programs and programs taking place on UGA properties are accessed through UGA’s Professional Education Portal. 

To access these online trainings, follow the directions below:

1. If you are an individual who will be working with a minors program or activity, go to UGA Protection of Minors Training to access the online training. On the page you will need to click "Request" in the top right corner to launch the training. Once you have completed the training provide the certificate of completion to your Program/Activity Administrator.

2. If you are a UGA Program/Activity Administrator, share the link with all of your staff who need to complete the training. You can assign the training in PEP but only to your direct UGA reports. All others can just access the training directly via the PEP link. Retain certificates of completion for all staff in accordance with Records Retention Schedule requirements. Contact the Director of Compliance at programsforminors@uga.edu if you need any assistance.

3. If you are a third party Program/Activity Administrator or have non-UGA affiliated staff working with your Program/Activity, you will need to contact the Director of Compliance at programsforminors@uga.edu for assistance in accessing the training through eLC..

If you have any issues with the training modules, contact the Director of Compliance at programsforminors@uga.edu for assistance.

Additional Training Resources:

Guidance Documents:  These documents provide guidance on Program/Activity planning and safe operations. Program Administrators and staff should review these documents to ensure safe operations.

1.  UGA Programs Serving Minors Information Sheet:  This guide reviews the required steps to be in compliance with the UGA Programs Serving Minors Policy:  Information Sheet

2.  Best Practices Guide:  This guide covers a variety of areas to help with planning and safe operations of Programs/Activities:  Best Practices Guide

3.  Two-Adult Rule Guidelines:  The Two-Adult Rule ensures the safety of both minors and Program/Activity Staff.  This document provides details for your Program/Activity on the Rule:  Two-Adult Rule Guidelines

4. Youth Mental Health Support Guide:  This guide provides information on assisitng a minor going through a mental health issue while at a minors program:  Youth Mental Health Support Guide

5.  Missing Minors Guide:  This document provides instruction on steps to take if a minor is found to be missing from a program:  Missing Minors Guide

Program/Activity Sample Documents:  These documents are samples of operational guides to assist Program/Activity Administrators and staff in safely managing operations.

1. Injury and Incident Reporting Form:  This form can be used to record injuries or incidents during Program/Activiity operations:  Injury and Incident Reporting Form
2. Sample Staff Manual:  This is an example of a staff manual that can be used to prepare an operational manual for your Program/Activity:  Staff Manual
3. Medication Best Practices:  This provides an overview of the best practices to handling medication during a Program/Activity:  Medication Best Practices
4. Sample Medication Policy:  This is an example of a Program/Activity policy on handling medication:  Medication Policy
5. Sample Medication Administration Record:  This is an example of a form to record medication taken during a Program/Activity:  Medication Administration Record