# Medication administration log

Source: https://backpr.com/resources/templates/medication-administration-log. Last updated: 2026-10-19.

Records every dose of medicine staff give a child: date, time, dose, who gave it and any reaction. Use one log per child, per medicine.

Free download: PDF https://backpr.com/media/templates/backpr-medication-administration-log.pdf · Word https://backpr.com/media/templates/backpr-medication-administration-log.docx

> Use one log for each child and each medicine. Give medicine only if the parent or guardian's signed medication form is on file and the medicine is in its original labeled container. Follow the label (or the doctor's written instructions for prescriptions) exactly. If anything doesn't match the parent's form, don't give the medicine. Call the parent and the director.

**Child and medicine**
- Child's full name: ______
- Date of birth: ______
- Allergies: ______
- Medicine name and strength: ______
- Dose and how it's given (such as by mouth or inhaler): ______
- Times to give it: ______
- Start and end dates: ______
- Expiration date (don't give expired medicine): ______
- Prescribing doctor (for prescriptions): ______
- Where the medicine is stored: ______
- Signed medication form on file (date): ______

**Five checks before every dose**
Check all five before every dose, then write it down right away.
- Right child
- Right medicine
- Right dose
- Right time
- Right way (such as by mouth, inhaled or on the skin)

**Doses given**
Write down every dose, including missed or refused doses and why.
| Date | Time | Dose given | Given by (initials) | Child's reaction or notes | Parent told (if needed) |
| --- | --- | --- | --- | --- | --- |

**Staff initials**
Everyone who gives medicine from this log prints their name and signs once here.
| Initials | Printed name | Signature |
| --- | --- | --- |

**Medicine returned**
- Medicine returned to the parent (date and amount left): ______
- Returned by (staff) and received by (parent or guardian): ______

### How to use it
- Keep the log with the medicine, locked up or out of children's reach, and bring both on field trips.
- Write in pen and record each dose right after giving it. To fix a mistake, cross it out with one line and initial it.
- If a child gets the wrong medicine or dose, call Poison Control at 1-800-222-1222 right away (or 911 if the child is very sick), then tell the director and the parent. If a dose is missed or late, tell them the same day. Fill out an incident report either way.
- Check your state's licensing rules on who may give medicine, what training they need and which records you must keep.

**Can camp or after-school staff give kids medicine?**
Usually yes, with written permission from a parent or guardian, the medicine in its original labeled container and, for prescriptions, the doctor's instructions. Rules on training and paperwork vary, so check your state's licensing rules.

**How long should we keep medication logs?**
Keep completed logs in the child's file for as long as your state's licensing rules and your insurer require. Store them securely, because they contain health information.

Free to use and change, but not legal or medical advice. Check your state's licensing rules and your insurer's requirements, and have a lawyer review any consent or waiver language.