Babysitter’s Poison Checklist

Child’s full name:_______________________________

Age:________________ Weight:___________________

Allergies:______________________________________

Medical conditions:_____________________________

______________________________________________

Current medications (including dose and times given):

______________________________________________

______________________________________________

______________________________________________

Insurance/Medical record #:_______________________

Hospital name and number:_______________________

Parents can be reached at:________________________

Parents will return at:____________________________

In an emergency call:_____________________________

The syrup of ipecac is located:_____________________

If babysitting at child’s home add the following:

This address is:_________________________________

This phone number is:___________________________