Asthma Medication Administration Record

Add it, send the link, collect the answers

No setup and no credit card. The form below works exactly as it is.

1Add this form to your service — one sign-up, free.
2Send your educators the link. They open it on any device and enter your staff PIN — you won’t be asked while you’re signed in.
3Answers come back signed and land in your inbox as soon as they’re submitted.

What the asthma medication administration record looks like

Every question, exactly as your educators will see it. Scroll inside the frame to read the whole form.

About the Asthma Medication Administration Record

A digital asthma medication administration record built around Regulations 92, 94 and 95 of the Education and Care Services National Regulations. Regulation 94 allows medication without an authorisation in an asthma emergency, after which a parent and emergency services must be notified as soon as practicable. This form captures asthma signs and symptoms observed, Ventolin administration details including dosage, spacer use, and expiry date, witness verification, and a multi-step signing workflow with responsible person review and parent acknowledgement including previous administration details.

Also called

Asthma medication record
Asthma medication administration form
Asthma MAF

What's on this form

Every question included in the asthma medication administration record. Add, remove or reword any of them in the form builder.

Step 1 — Completed first

Filled in by the educator or responsible person

Child
Child details
Asthma Signs And Symptoms
Date Signs And Symptoms Presented
Date
Time Signs And Symptoms Presented
Time
Session Type
- Before School Care
- After School Care
- Vacation Care
Choose one
Signs And Symptoms Observed or Described
- Coughing
- Wheezing
- Tightness of Chest
- Difficulty Breathing
Choose any
First Educator On Scene
Short answer
Description or Comments
Long answer
Administration Details
Time of Administration
Time
Who's Ventolin Inhaler Was Used?
Short answer
Ventolin Expiry Date
Date
Spacer Used? (Allows higher dosage of Ventolin)
Yes / No
Puffs Delivered (child will sit up straight, shake puffer)
Short answer
Who Administered?
Short answer
Person who witnessed administration and checked dosage was correct
Educator signature
Notification Notes
Person Completing Form
Educator signature

Step 2 — Responsible Person

Completed by a staff member at the service

Responsible Person Details
Educator signature

Step 3 — Parent / Guardian

Sent to the parent or guardian to sign

Medication Last Administered
Date Of Previous Administration
Date
Time Of Previous Administration
Time
Parent/Guardian Signature
Signature

How this form gets signed

This template runs as a multi-step signing workflow. Each person is notified in turn, and every signature is timestamped and stored against the record.

1
Responsible Person
Signs inside the service, using a staff PIN
2
Parent/Guardian
Signs externally — receives a secure link by email, no account needed

Australian regulations this form supports

The asthma medication administration record is built around the Education and Care Services National Regulations. These are the regulations it helps you meet.

Reg 90

Medical conditions policy

The medical conditions policy must set out how medical conditions are managed — including asthma, diabetes and a diagnosis that a child is at risk of anaphylaxis — how staff and volunteers are informed of those practices, and what is required when an enrolled child has a specific health care need, allergy or relevant medical condition.

Read the full text of Reg 90

(1) The medical conditions policy of the education and care service must set out practices in relation to the following— (a) the management of medical conditions, including asthma, diabetes or a diagnosis that a child is at risk of anaphylaxis; (b) informing nominated supervisors and staff members of, and volunteers at, the service of practices in relation to managing those medical conditions; (c) the requirements arising if a child enrolled at the education and care service has a specific health care need, allergy or relevant medical condition, including— (i) requiring a parent of the child to provide a medical management plan for the child; and (ii) requiring the medical management plan to be followed in the event of an incident relating to the child's specific health care need, allergy or relevant medical condition; and (iii) requiring the development of a risk-minimisation plan in consultation with the parents of a child— (A) to ensure that the risks relating to the child's specific health care need, allergy or relevant medical condition are assessed and minimised; and (B) if relevant, to ensure that practices and procedures in relation to the safe handling, preparation, consumption and service of food are developed and implemented; and (C) if relevant, to ensure that practices and procedures to ensure that the parents are notified of any known allergens that pose a risk to a child and strategies for minimising the risk are developed and implemented; and (D) to ensure that practices and procedures ensuring that all staff members and volunteers can identify the child, the child's medical management plan and the location of the child's medication are developed and implemented; and (E) if relevant, to ensure that practices and procedures ensuring that the child does not attend the service without medication prescribed by the child's medical practitioner in relation to the child's specific health care need, allergy or relevant medical condition are developed and implemented; and (iv) requiring the development of a communications plan to ensure that— (A) relevant staff members and volunteers are informed about the medical conditions policy and the medical management plan and risk minimisation plan for the child; and (B) a child's parent can communicate any changes to the medical management plan and risk minimisation plan for the child, setting out how that communication can occur. (2) The medical conditions policy of the education and care service must set out practices in relation to self-administration of medication by children over preschool age if the service permits that self-administration. (3) In subregulation (2), the practices must include any practices relating to recording in the medication record for a child of notifications from the child that medication has been self-administered.

Reg 92

Medication record

A medication record must be kept for every child to whom medication is or is to be administered, including the child's name, the authorisation to administer it, and the details of each dose given.

Read the full text of Reg 92

(1) The approved provider of an education and care service must ensure that a medication record is kept that includes the details set out in subregulation (3) for each child to whom medication is or is to be administered by the service. (2) A family day care educator must keep a medication record that includes the details set out in subregulation (3) for each child being educated and cared for by the educator as part of a family day care service to whom medication is or is to be administered. (3) The details to be recorded are— (a) the name of the child; (b) the authorisation to administer medication (including, if applicable, self-administration), signed by a parent or a person named in the child's enrolment record as authorised to consent to administration of medication; (c) the name of the medication to be administered; (d) the time and date the medication was last administered; (e) the time and date, or the circumstances under which, the medication should be next administered; (f) the dosage of the medication to be administered; (g) the manner in which the medication is to be administered; (h) if the medication is administered to the child— (i) the dosage that was administered; and (ii) the manner in which the medication was administered; and (iii) the time and date the medication was administered; and (iv) the name and signature of the person who administered the medication; and (v) if another person is required under regulation 95 to check the dosage and administration, the name and signature of that person.

Reg 93

Administration of medication

Medication must not be administered to a child unless that administration is authorised and the medication is given in accordance with regulation 95 or 96.

Read the full text of Reg 93

(1) The approved provider of an education and care service must ensure that medication is not administered to a child being educated and cared for by the service unless— (a) that administration is authorised; and (b) the medication is administered in accordance with regulation 95 or 96. (2) The approved provider of an education and care service must ensure that written notice is given to a parent or other family member of a child as soon as practicable, if medication is administered to the child under an authorisation referred to in subregulation (5)(b). (3) A nominated supervisor of an education and care service must ensure that medication is not administered to a child being educated and cared for by the service unless— (a) that administration is authorised; and (b) the medication is administered in accordance with regulation 95 or 96. (4) A family day care educator must ensure that medication is not administered to a child being educated and cared for by the educator as part of a family day care service unless— (a) that administration is authorised; and (b) the medication is administered in accordance with regulation 95 or 96. (5) In this regulation the administration of medication to a child is authorised if an authorisation to administer the medication— (a) is recorded in the medication record for that child under regulation 92; or (b) in the case of an emergency, is given verbally by— (i) a parent or a person named in the child's enrolment record as authorised to consent to administration of medication; or (ii) if a parent or person named in the enrolment record cannot reasonably be contacted in the circumstances, a registered medical practitioner or an emergency service.

Reg 94

Exception to authorisation requirement — anaphylaxis or asthma emergency

Medication may be administered to a child without an authorisation in an anaphylaxis or asthma emergency. If it is, a parent of the child and emergency services must be notified as soon as practicable.

Read the full text of Reg 94

(1) Despite regulation 93, medication may be administered to a child without an authorisation in case of an anaphylaxis or asthma emergency. (2) If medication is administered under this regulation, the approved provider or a nominated supervisor of the education and care service or family day care educator must ensure that the following are notified as soon as practicable— (a) a parent of the child; (b) emergency services.

Reg 95

Procedure for administration of medication

How medication must actually be given: from its original container, bearing the original label and instructions — and, where prescribed, the child's name — before the expiry or use-by date, and in accordance with any instructions attached to it or given by a registered medical practitioner. Except in a family day care service or a service permitted to have only 1 educator, a second person must check the dosage and the child's identity. Subject to regulation 96.

Read the full text of Reg 95

Subject to regulation 96, if medication is administered to a child being educated and cared for by an education and care service— (a) the medication must be administered— (i) if the medication has been prescribed by a registered medical practitioner, from its original container, bearing the original label with the name of the child to whom the medication is to be administered, and before the expiry or use by date; or (ii) from its original container, bearing the original label and instructions and before the expiry or use by date; and (b) the medication must be administered in accordance with any instructions— (i) attached to the medication; or (ii) any written or verbal instructions provided by a registered medical practitioner; and (c) except in the case of a family day care service or an education and care service that is permitted to have only 1 educator to educate and care for children, the following must be checked by a person other than the person administering the medication— (i) the dosage of the medication to be administered; (ii) the identity of the child to whom the medication is to be administered.

Provided for information only and may not reflect the latest amendments. Refer to the Education and Care Services National Regulations (NSW) for the official legal text.

Where this form fits

The asthma medication administration record is part of these jobs — each guide walks through the whole sequence and the other forms that go with it.

Daily records: what educators fill in as things happen

The records your staff complete during the day — incidents, illness, medication given, and observations of children’s learning.

Forms your educators fill in

The records staff complete — incidents and illness, medication given, observations, safety checks and transport.

Questions about the asthma medication administration record

What is the asthma medication administration record used for?

Who fills in the asthma medication administration record?

The asthma medication administration record is completed by educators or the responsible person at the service. Staff open it on any device and sign with a service PIN, so there's no separate login to manage. It then moves through 2 signing steps — Responsible Person and Parent/Guardian — with each signature timestamped against the record.

Which regulations is the asthma medication administration record built around?

It is built around Reg 90, Reg 92, Reg 93, Reg 94 and Reg 95 of the Education and Care Services National Regulations. Reg 90 covers medical conditions policy. Reg 92 covers medication record. Reg 93 covers administration of medication. Reg 94 covers exception to authorisation requirement — anaphylaxis or asthma emergency. Reg 95 covers procedure for administration of medication. Check the form against the regulation text for your service before you use it.

Is the asthma medication administration record the same as an asthma medication record?

Yes. Different services use different names for this form — it is also called asthma medication record, asthma medication administration form and asthma maf. They all describe the same record, and this template covers it. You can rename it to whatever your service already calls it.

Can I change the questions on the asthma medication administration record?

Yes. The template comes with 23 fields ready to go, but you can add, remove, reword or reorder anything in the drag-and-drop form builder, and add your own conditional logic and signing steps. Your changes only affect your service's copy.

Is the asthma medication administration record free?

Yes — the asthma medication administration record is free to use on the Childcare Forms free plan. No credit card is required to create an account and start sending it.