Piedmont Unified School District · January 2015 Establish enrollment projection for initial revenue and expenditure estimates January 9, 2015 Governor releases proposal for the subsequent

Piedmont Unified School District

Budget Development Calendar

Fiscal Year 2015-16

The development of the annual budget is an important process that helps to ensure fiscalsolvency and the achievement of the District’s educational goals. The process begins early sothat timely decisions can be made to adjust existing programs and to evaluate newexpenditure proposals for possible inclusion in the adopted budget. The Budget AdvisoryCommittee (BAC) is a standing committee with representatives from all stakeholders in theDistrict. It is advisory in nature with members representing the interests of all programs andservices for the District as a whole. Its purpose is to review the District’s Budget, share theinformation with constituent groups and generate recommendations for Board consideration inthe Budget development process. As part of the passage of Parcel Tax Measure A, the Boardof Education appoints members of the community to serve as part of the School Support Tax(SST) Advisory Subcommittee to review the District’s budget and provide recommendations tothe Board as to the annual levy of the Parcel Tax. The meetings are posted and open to thepublic. Members who were appointed by the Board serve at least a two-year term. Members ofthe community are also encouraged to provide input in the budget development processthrough the Budget Advisory Committee, the SST Advisory Subcommittee, Parent ClubMeetings, Board Meetings and directly to staff.

Dates of scheduled Regular Board Meetings indicated in bold

January 2015 Establish enrollment projection for initial revenue andexpenditure estimates

January 9, 2015 Governor releases proposal for the subsequent year’sbudget (2015-16)

January 14, 2015 Presentation and Acceptance of 2013-14 Annual AuditReport

January 15, 2015 PUSD stakeholders attend Governor’s Budget Workshop inSacramento (School Services of California) to reviewGovernor’s budget proposals for 2015-16. Review with BACand CAC

January 27, 2015 Board meeting to review Governor’s proposed budget andthe District budget process, including staffing based on initialenrollment projections and First Interim Report; Boardapproval of 2015-2016 Budget Development Calendar.

February 11, 2015 With the release of the Governor’s 2015-16 proposedbudget, the Board will provide direction on use of GeneralFund resources to support categorical programs for 2015-16and beyond. If necessary, review preliminary list of anycertificated layoffs for 2015-16 school year (there are no

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proposals for certificated layoffs anticipated for the purposeof reducing expenditures).

End of every February Legislative Analyst comments on Governor’s proposal andrecommends technical corrections

March 11, 2015 Present 2014-15 Second Interim Report, determinerecommendation for certification as to the District’s ability tomeet its financial obligations for the current and twosubsequent fiscal years.

March 25, 2015 Begin discussion on District Goals for 2015-16 to coincidewith budget considerations as part of the District’s LocalControl Accountability Plan (LCAP). Include input fromcommunity and support groups; first Public Hearing for theBoard to determine the parcel tax levy and amount forMeasure A; annual report from the SST AdvisorySubcommittee with recommendations as to the levy ofparcel taxes.

March 31, 2015 Begin LCAP process of which the template is based oneight (8) specific areas: Implementation of Common CoreState Standards; Student Achievement; StudentEngagement; School Climate; Course Access; ParentalInvolvement; Basic Services; and Other Student Outcomes

April 22, 2015 Hold second Public Hearing to determine levy of parcel tax;continue discussion of District Goals including budgetpriorities for the development of the District 2015-16 budget;review preliminary list of classified layoffs for 2015-16 schoolyear (if necessary), though no proposals for classified layoffsare anticipated for the purpose of reducing expenditures.

End of April Conduct special meeting to adopt resolution for classifiedlayoffs (if any), per 60-day notice requirement for layoff as ofJune 30, 2015.

May 13, 2015 Budget Advisory Committee recommendations presented toBoard; Board provides staff with direction for thedevelopment of the 2015-16 District Budget; present draftDistrict Goals for 2015-16.

May 15, 2015 Governor proposes 2015-16 State budget revisions in “MayRevise.”

May 27, 2015 Adopt District Goals for 2015-16. Conduct public hearing for“Flexibility Transfers” and adopt resolution to transfercategorical grant funds to other District-eligible programs.

June 10, 2015 Preliminary 2015-2016 District Budget and LCAP draftpresented to Board.

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By every June 15 Constitutional deadline for legislature to send proposedbudget to Governor

June 24, 2015 Governing Board holds public hearing on 2015-16 proposedbudget and adopts District budget; District submits adoptedbudget to County Superintendent of Schools and adoptsresolution to authorize year-end budget transfers; Budgetavailable for public inspection three days prior to publichearing and will be included as part of the Board Meetingmaterials posted online and distributed. The District willapprove the LCAP for 2015-16.

By every June 30 Governor signs/vetoes final State Budget

July 1, 2015 Date by which the Board of Education must approve the2015-16 annual budget and adopt the Local ControlAccountability Plan (LCAP)

By every August 15 County Superintendent (COE) shall approve or disapprovethe District’s adopted budget

By every August-September Revise 2015-2016 District budget based upon Final StateBudget; Close District accounting records; provide 2014-15unaudited actual financial data to Governing Board. Districtrevises budget, reflecting changes in projections of incomeand expenditures; BAC and SST Advisory Subcommitteeconvened to review budget and make recommendations tothe Board; revised budget made available to the public; filebudget with COE.

By every December 15 Present First Interim Report. The 2015-16 operating budgetis revised based on actual expenditures through October 31,2015 with multi-year projections for 2016-17 and 2017-18.

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Board Meeting ofJanuary 27, 2015

TO: Board of Education

FROM: Constance Hubbard, SuperintendentMichael Brady, Assistant SuperintendentSong Chin-Bendib, Chief Business Official

SUBJECT: REVIEW DISTRICT FACILITIES USE HANDBOOKPROVIDE DIRECTION ON METHODOLOGY FOR DEVELOPMENT OFFEE SCHEDULE BASED ON CIVIC CENTER ACT REQUIREMENT

I. SUPPORT INFORMATION

At its November 12, 2014 meeting, the Board reviewed a first draft ofmodifications to the District’s current Facilities Use Handbook, which has notbeen updated since 2010. The reasons for the review are threefold: First, toexplore expansion of facility hours of operation per the passage of SB 1404 inJanuary of 2014; second, to clarify the District’s permit process and insurancerequirements for users seeking to reserve District facilities; and third, to examinethe current schedule of fees and fee group types in light of revisions to the CivicCenter Act (Ed Code 38130 et seq.), expanding the definition of direct costs thata school district may charge for use of its school facilities or grounds.

Expansion of Facility Hours of Operation

The Board approved increasing hours for weekend facilities use at PiedmontHigh School and Piedmont Middle School as supported under SB 1404 to“maximize opportunities to make available and accessible public facilities andgrounds…as civic centers.” Additionally, and in concert with Board Policy 7300,expanding available permit hours necessitates adding additional custodial stafftime so that permits will be issued “during times when a custodian or appropriatesupervisor is present.” For purposes of the Facilities Use Handbook, a Districtsupervisor is identified as an individual or individuals whose duties, under BoardPolicy 4119.3, are subject to Board of Education policies, “administrativeregulations, applicable laws and current employee [collective bargaining]agreements.”

Although current demand for facilities still greatly exceeds the District’s capacityto provide time to every organization as requested, the Piedmont Unified SchoolDistrict remains committed to looking for ways to augment access of facilities tothe general public. The increased hours of operation can be found on page 6 ofthe Handbook, where PHS/PMS auditoriums, gymnasiums, and multi-purposerooms (including the PHS Student Center) are available for use until 9:00 pm.

The proposal aligns operational hours with current staff schedules. Althoughweekend rental of elementary school auditoriums remains unavailable, with

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additional custodial staff time and overlapping schedules some flexibility inaccommodating weekend (site-based) events can be better supported.

Permit Process and Insurance Requirements

When not in use by the District (either during the school day or for events) andnot reserved pursuant to a permit, the District’s facilities are available for generalpublic use during the times set forth next to each facility. Priorities for facilitiesuse as defined in the Handbook remain largely unchanged, except for therecognition of Piedmont-based sports organizations and their priority use ofDistrict athletic facilities, consistent with SB 1404 (section 38134), which statesthat governing boards “shall authorize the use of school facilities or groundsunder its control by a nonprofit organization, or by a club or an associationorganized to promote youth and school activities.”

These organizations primarily serve Piedmont residents, have long standingcommitments to provide opportunities to Piedmont youth, and rely on some levelof availability of District facilities. A number of groups have entered into one ormore Memorandum of Understanding (MOU) with the District and have alsoagreed to make ongoing donations to the District for future expenses at theDistrict’s athletic facilities. Under proposed changes to the Handbook, theseorganizations would be defined as “Program Partners” (see next section).

Regardless of order in priority use, groups and organizations will continue toreserve time to use specific District by obtaining necessary permits. For ease ofuse, applicants will be provided with a link to the District’s new online reservationsystem (see Consent Calendar). Making a reservation online constitutes arequest to the District for a reservation; the District must confirm and receive siteapproval for the reservation before any assumption that a request has beengranted. In addition, groups must provide the District with proof of at least $1million in liability insurance coverage, specifically naming the Piedmont UnifiedSchool District as an Additional Insured. Further, a group’s use of any Districtfacility constitutes the group’s agreement to defend and indemnify the Districtagainst any claims or liability arising out of the group’s use of the facility.

The Revised Civic Center Act: Fee Group Types and Fee Schedules

It was the intent of the Legislature in revising the Civic Center Act to reinforce the“valuable contributions school districts make to their communities by providingneeded space for recreational activities.” The Civic Center Act states that “schooldistricts have an obligation to protect and preserve public school facilities andgrounds for the safety and enjoyment of students and community members whouse them.” Since around 2008, the ability of school districts to maintain facilitiesand grounds has been jeopardized due to severe budget cuts. Although Statefunding is slowly being restored to 2007-08 levels, State-mandated increases inthe District’s CalSTRS and PERS contributions and other expenses limit thefunds that can be devoted to facilities and grounds. Thus, sharing of such costsremains critical to preserving such facilities and grounds for use.

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Before its recent revision, the Civic Center Act only allowed school districts torecover their “direct costs” from most non-profit groups that used their facilities.“Direct Costs” was defined as “those costs of supplies, utilities, janitorial services,services of any other district employees, and salaries paid school districtemployees necessitated by the organization’s use of the school facilities andgrounds of the district.”

The amended Civic Center Act expands the definition of what constitutes directcosts that a school district may charge to include (a) “The share of the costs ofsupplies, utilities, janitorial services, services of school district employees, andsalaries paid to school district employees directly associated with theadministration of this section to operate and maintain school facilities or groundsthat is proportional to the entity’s use of the school facilities or grounds” and (b)for non-classroom spaces, “The share of the costs for maintenance, repair,restoration, and refurbishment, proportional to the use of the school facilities orgrounds by the entity using the school facilities or grounds.”

The Revised Civic Center Act: Fee Group Types

On page 5 of the revised Handbook, Section 4 has been expanded to include notonly the priorities in allocating reserved use of facilities, but also a description ofthe types of fee groups as they relate to a revised fee schedule. The PiedmontUnified School District currently has a list of over 200 active organizations (a listof organizations is attached) that rent facilities in PUSD. Under the revisedHandbook, each organization would be identified within one of four Fee GroupTypes as outlined (with a general description) below:

Civic Users: Organizations or individuals from the local community who use theschool facilities for civic purposes, such as voting, community meetings, informalrecreation, and shelter in an emergency. Civic Users are exempt from fees.

Program Partners: Organizations or other public agencies that use the schoolfacilities and whose primary purpose is to provide programs and/or services toadvance the academic success of children in school. Program Partners would bealigned with the current “Direct Rental” fee schedule, which is approximately 60%of the current “Fair Rental” rates.

Community Users: Non-profit organizations or other public agencies that use theschool facilities and whose primary purpose is to provide programs and/orservices that serve the local neighborhood or community. Community Userswould be aligned with current “Fair Rental” rates.

Private Users (1): Private organizations, for profit or non-profit, that are using thefacility to raise revenue. Private Users (1) can be aligned with current Fair Rentalrates

Private Users (2): For profit organizations that are using a facility for businesspurposes. Private Users (2) can be aligned with current Fair Rental rates.

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The Revised Civic Center Act: Fee Schedules

In consideration of the Civic Center Act’s expanded definition of “direct costs” toinclude repairs, restoration, and refurbishment of facilities, determining the actualcosts of owning and operating facilities (and creating a fair fee structure) can bechallenging for school districts. At the Board meeting of November 12, 2014,District staff utilized a “School Facilities Cost Calculator” (developed by the 21stCentury School Fund - a nonprofit organization dedicated to modernizing publicschool facilities - and the Center for Cities & Schools at the University ofCalifornia, Berkeley). The “School Facilities Cost Calculator” was designed toassist school districts and communities determine the costs of owning andoperating their facilities in an effort to develop a fair and transparent feestructure. Assumptions are built into the calculator which include studentenrollment, total building gross square footage, current building replacement costper square foot, expected average building lifespan, estimated hours ofoperation, maintenance and operations costs, administrative costs by school siteand district-wide, capital outlay, and long-term debt. Capital costs are estimatedto reflect responsible facilities stewardship, but operating and administrativecosts are actual expenditures and in some instances are underfunded.

Actual Costs and Replacement Cost Assumptions

For the purposes of assisting the Board in determining a fee schedule thatreflects changes allowed under the Civic Center Act, preliminary calculationscombining actual costs plus replacement costs for District buildings (gyms,auditoriums, theater, multi-purpose rooms, grass fields, and synthetic fields) willbe provided for consideration. Classrooms (per the Civic Center Act), as well asfees for lights, sound systems, pianos, custodial hours, etc. calculations areexcluded in determining hourly amounts for actual costs. It should be noted thatnot all costs (such as utilities) can be tied precisely to an individual site (like thesoftball field).

The committee that includes Board Members and staff will review the variousoptions for the calculations to be used for the revised schedule.

The Board is requested to review the Handbook and approve the changes asproposed. Based on direction from the Board of Education this evening staff willbring the Handbook and a proposed facilities fee schedule for approval inFebruary.

II. RECOMMENDATION: INFORMATION – PROVIDE DIRECTION

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Piedmont Unified School DistrictFacilities Use Handbook

Page 1, January 2015

PIEDMONT UNIFIED SCHOOL DISTRICTPiedmont, California

Facilities Use Handbook

January 2015(Seventh Publication)

Deleted: May

Deleted: 2011December, 2014

Deleted: Sixth



Contents

Section 1: Overview .............................................................................................................................- 3 -Section 2: Access...................................................................................................................................- 4 -Section 3: Acceptable Behavior ..........................................................................................................- 5 -Section 4: Priorities in Allocating Reserved Use and Fee Group Types ......................................- 5 -Section 5: Facilities—Locations, Use and Restrictions....................................................................- 6 -Section 6: Reservations, Permit Application Process and Requirements and Payments ..........- 7 -Section 7: Applicable Policies and Other Requirements ................................................................- 8 -Section 8: Guidelines for Facility Use..............................................................................................- 10 -

Section 9: Facility Fee ScheduleSection 10: Map of City of Piedmont .................................................................................

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Section 1: Overview

Piedmont Unified School District (the District) welcomes your interest in use of the District facilities. The Districtstrives to serve the Piedmont community not only through its educational programs for students, but also bymaking its facilities available for public use in a manner that does not conflict with school activities. Piedmonthas a shortage of public facilities, particularly fields and gyms, and there is often far more demand than theDistrict is able to accommodate. All use of District facilities for non-school activities is at the District’s sole andunfettered discretion, and users must comply with the rules stated in this handbook.

The following is an overview of the District rules for use of its facilities, discussed in more detail in later sections.

1. The District has first priority in the use of District facilities. The school day, including school athletic andenrichment programs, runs from 8:00 a.m. through 3:30 p.m., Monday through Friday, during the schoolyear. The District’s athletic facilities also are used by school sports teams, and Piedmont RecreationDepartment’s Schoolmates programs; public use of the same venue is not permitted during such use. Theschool year usually runs from late August through mid-June; the exact dates for each year can be foundon the District website. School events, including athletic events, also may occur on weekends. During theschool day, public use of the District’s facilities is not permitted. During school events on weekends,public use of the event venue is not permitted. Use of the District’s facilities not being used for schoolactivities is at the discretion of the District.

2. Pursuant to a District facilities use agreement with the City of Piedmont, the City Recreation Departmenthas second priority rights to many of the District’s facilities to offer Recreation Department programs,when such facilities are not being used for District purposes.

3. The District also has entered into one or more Memorandum of Understanding (MOU) with Piedmont-based sports organizations for use of District athletic facilities. These organizations are not for profit,primarily serve Piedmont residents, have long standing commitments to provide opportunities toPiedmont youth, and rely on some level of availability of District facilities. Such organizations also haveagreed to make ongoing donations to the District for future expenses at the District’s athletic facilities.Organizations with MOUs may be given preference in reserving time for use of District facilities. Anynot-for-profit, Piedmont-based organization meeting the above criteria may seek an MOU with theDistrict

4. Groups and organizations may seek to reserve time to use specific District facilities identified herein byobtaining a permit. As set forth below, the first step is to contact the District’s Facilities Manager.Necessary paperwork must be provided and then, following internal approval, a link will be provided tothe District’s reservation system. Making a reservation online constitutes a request to the District for areservation; the District must confirm the reservation before the request is granted. Without Districtconfirmation, there is no permit.

Before any District facility may be used, the permit holder of the facility must procure and maintain aminimum of $1 million in liability coverage for bodily injury and property damage per occurrence with anaggregate limit of no less than $2 million, and the permit holder must provide two documents which list“Piedmont Unified School District” as an “additional insured” on the liability policy: (1) a Certificate ofLiability Insurance; and, (2) an endorsement page which modifies the insurance policy by naming“Piedmont Unified School District” as an “additional insured”. Failure to provide both of thesedocuments at least 15 calendar days prior to the use of the District facility will result in the cancellation ofthe facility use permit.

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Further in making an application for use of facilities, all permit holders agree to defend, indemnify andhold harmless the District, its officers, employees and agents from and against any and all liability, cost,expense, claims, injuries, losses or damages, including damage to District property, which may result orarise in any way out of the permit holder’s use or occupancy of the facilities, negligence of the permitholder’s group, its officers, employees or agents.

5. When not in use by the District (either during the school day or for events), and not reserved pursuant to apermit, the District’s athletic facilities are available for general public use during the times set forth foreach facility in Section 5 below. During the general public use time, the District’s intent is to provide anopportunity for Piedmont residents to exercise and play at its athletic facilities. For-profit use isprohibited; any person or organization wishing to offer coaching or other programs at District facilitiesmust obtain a permit. Organized groups that intend to use a portion of any athletic facility in a mannerthat would exclude other persons from using that portion of the facility must obtain a permit.

6. All individuals using District facilities must be respectful and courteous of other users, audience, andDistrict representatives at all times. All non-District activities at District facilities are permitted only at theDistrict’s discretion. Any District representative may revoke the District’s permission for an individual orgroup to be present at a District facility. If asked to leave by a District representative, the person requestedshould do so. Any complaint regarding such a request should be made to the District’s Facilities Manager.

Section 2: Access

Students are the primary users of the Piedmont Unified School District facilities during the school day and schoolevents. During the school day, public use of the District’s facilities is not permitted. During school events onweekends, public use of the event venue is not permitted. During the school year, the school day at Piedmontschools is as follows:

Beach, Havens and Wildwood elementary schools run from 8:00 a.m. to 3:30 p.m. Please note that theCity Schoolmates program also uses a portion of the playground at these sites from 7:30 a.m. to 6:00 p.m.

Piedmont High School, Millenium High School, and Piedmont Middle School run from 7:45 a.m. to 3:30p.m.

The school year usually runs from late August through mid-June; the exact dates for each year can be found onthe District website. During these times, public use of these sites is not permitted. Visitors to these sites mustcheck in at the site office, and obtain a pass to be present on campus.

In addition to its school facilities, the Piedmont Unified School District manages, maintains, and operates theWitter Complex (football field, baseball field, softball field, track, and restrooms). During the school day, publicuse of the Witter Field Complex is not permitted; use is prohibited from 7:30 a.m to 3:30 p.m. on school daysduring the school year, Use will also be prohibited during after school hours, as needed, in support of Districtathletic programs, including practices, scrimmages, games, and post-season use. Public use of the event venue isnot permitted during school events.

There are occasions when the public may wish to use parts of the Witter Complex that are not being used by anathletic team after 3:30 p.m. In the interest of public safety, users must follow the directions of Districtemployees, who have sole discretion in closing off portions of Witter Complex during athletic practices orcompetitions.

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At the discretion of the school principals and the District, outside users may reserve and apply for a permit to usethe facilities, when not being used by these primary users. Although demand for District facilities often exceedsavailable capacity, the District is committed to providing permits to Piedmont community groups and Piedmontyouth sports programs in support of a broader and more balanced use of District facilities by the entirecommunity.

Section 3: Acceptable Behavior

All individuals using District facilities must be respectful and courteous of other users, audience, and Districtrepresentatives at all times. Given the demand for athletic play and exercise space, sharing will often be required.As noted above, public use is not permitted during the school day and during school events. Individualsattempting to use District facilities during such times will be asked to leave. Permit holders have priority duringthe reserved time; individuals seeking to use the same facility during the reserved time will be asked to leave.More specific information is provided in Section 8, Guidelines for Facility Use: Classrooms, Auditoriums,Multipurpose Rooms, and Gymnasiums.Permit holders shall be responsible for the conduct and control of both patrons and participants, and must complywith all applicable state and federal laws, city ordinances, School District regulations, by-laws, and policies andpermit conditions. The Board and/or its agents reserve the right to suspend or prohibit any use of facilitiesregardless of prior approval or not.

Section 4: Priorities in Allocating Reserved Use and Fee Group Types

Subject to the exercise of its unfettered discretion in individual circumstances, the District allocates reserved useof District facilities in the following order:

1. School District, including Piedmont Adult School

2. Piedmont Recreation Department

3. Groups and organizations serving Piedmont students and youth (Groups with MOU’s with PUSDmay be given preference)

4. Groups and organizations serving Piedmont residents

5. Other groups and organizations

Fee Group Types:

Civic Users: Organizations or individuals from the local community who use the school facilities for civicpurposes, such as voting, community meetings, informal recreation, and shelter in an emergency. Civic Users areexempt from fees.

Program Partners: Organizations or other public agencies that use the school facilities and whose primarypurpose is to provide programs and/or services to advance the academic success of children in school.

Community Users: Non-profit organizations or other public agencies that use the school facilities and whoseprimary purpose is to provide programs and/or services that serve the local neighborhood or community.

Private Users (1): Private organizations, for profit or non-profit, that are using the facility to raise revenue.

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Deleted: User Group

Deleted: Piedmont Adult School and

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Private Users (2): For profit organizations that are using a facility for business purposes.

Note: All permits shall be revocable and shall not be considered as a lease, and the Board of Education or itsauthorized agent may reject any application or cancel any permit. A permit is not transferable. The District’s needto schedule maintenance or repair shall supersede the priority order for use of each facility.

Section 5: Facilities—Locations, Use and Restrictions

Facilities Available for UseFacilities that may be available for reserved use outside of the school day or during school events are listed in thetable below. For reservations or information, contact [email protected].

Facility Location/Address Weekdays Saturdays Sundays

Classrooms Elementary Schools: Beach, Havensand Wildwood

Not available Not available Not available

Piedmont Middle School (PMS)740 Magnolia Avenue

3:30 pm–10:00 pm 8:00 am–3:30 pm Not available

Piedmont High School (PHS)800 Magnolia Avenue


Auditoriums/Student Center

Beach Elementary School100 Lake Avenue

3:30 pm–8:00 pm Not available Not available

Wildwood Elementary School301 Wildwood Avenue


PHS Student Center800 Magnolia Avenue

3:30 pm–8:00 pm 8:00 am–9:00 pm 8:00 am–9:00 pm

Gymnasiums Morrison Gym at PMS740 Magnolia Avenue

3:30 pm–10:00 pm 8:00 am–9:00 pm 8:00 am–9:00 pm

Buzz Redford Gym at PMS740 Magnolia Avenue

3:30 pm–10:00 pm 8:00 am–9:00 pm 8:00 am–9:00 pm

Binks Gym at PHS800 Magnolia Avenue

3:30 pm–10:00 pm 8:00 am–9:00 pm 8:00 am–9:00 pm

MultipurposeRooms

Havens Elementary School325 Highland Avenue


Piedmont Middle School740 Magnolia Avenue

3:30pm–10:00 pm 8:00 am–9:00 pm 8:00 am–9:00 pm

Theaters Ellen Driscoll Theater at Havens325 Highland Avenue


Allen Harvey Theater at PHS800 Magnolia Avenue

Not available Not available Not available

Fields/Track Witter Field (synthetic turf)740 Magnolia Avenue

6:30 pm–8:00 am3:30 pm–9:00 pm

8:00 am–5:00 pm 8:00 am–5:00 pm

Humphries Diamond Baseball Field740 Magnolia Avenue

6:30 pm–8:00 am3:30 pm–9:00 pm

8:00 am–5:00 pm 8:00 am–5:00 pm

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Facility Location/Address Weekdays Saturdays Sundays

Softball Field740 Magnolia Avenue

6:30 pm–8:00 am3:30 pm–9:00 pm

8:00 am–5:00 pm 8:00 am–5:00 pm

Witter Track + component sections740 Magnolia Avenue

6:30 pm–8:00 am3:30 pm–9:00 pm

8:00 am–5:00 pm Not available

Becker Field at Havens325 Highland Avenue

6:30 pm–8:00 am3:30 pm–9:00 pm

8:00 am–5:00 pm Not available

Notes:

ALL FACILITIES ARE CLOSED FOR USE BY THE PUBLIC DURING SCHOOL HOURS

NO PERMITS WILL BE ISSUED ON NATIONAL HOLIDAYS, INCLUDING THE DAY AFTERTHANKSGIVING AND FROM DECEMBER 24 THROUGH JANUARY 1.

THE HUMPHRIES DIAMOND BASEBALL FIELD AND SOFTBALL FIELD ARE CLOSED TO ALLUSES FROM THANKSGIVING TO START OF FEBRUARY FOR MAINTENANCE, SEEDING ANDRESTING.

Witter and Becker synthetic fields may be closed on certain weekends for maintenance.

Beach and Wildwood playgrounds are not available for rental purposes.

Shared use of Witter Field is subject to District approval.

Parking at School Sites

Parking is limited at all school sites as only street parking is available. All parking restrictions, noted by signs andpainted curbs, are strictly enforced by the Piedmont Police Department according to California Vehicle Code#21113(a) and applicable City ordinances. Violators may be citedSunday Use Restrictions at Witter Athletic Field and Sports Complex

The track area is reserved for individual, casual runners and joggers only.

The El Cerrito access gate at Witter Field will be locked from Saturday at 5:00 p.m. until Monday at 6:00a.m. Users are encouraged to enter the field via the Winsor Gate or Wildwood stairs.

The Witter Field speaker system will not be available. Private and public address systems will not beallowed.

A District representative will be on site from 8:30 a.m. 5:00 p.m. on Sundays to open and close gates (only forpermit holders), restrooms, etc. and will have the authority to ask non-permitted user groups to leave the field. Inthe event that a group does not leave, the District representative will call the Piedmont Police Department forassistance. The District representative has the authorization to request arrest and/or citation for trespassing if sodeemed.

Section 6: Reservations, Permit Application Process and Requirements and Payments

Permit holders who would like to use District facilities for organized activities must request reservations andapply for a use permit. Making a reservation online constitutes a request to the District for a reservation; theDistrict must confirm the reservation before the request is granted. Without District confirmation, there is nopermit. Contact [email protected].

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Liability Insurance Requirement: Permit holders must provide proof of liability insurance, billingaddress, contact information—including an email address—and the official name of the organization.

Before any District facility may be used, the permit holder of the facility must procure and maintain aminimum of $1 million in liability coverage for bodily injury and property damage per occurrence with anaggregate limit of no less than $2 million, and the user must provide two documents which list “PiedmontUnified School District” as an “additional insured” on the liability policy: (1) a Certificate of LiabilityInsurance; and, (2) an endorsement page which modifies the insurance policy by naming “Piedmont UnifiedSchool District” as an “additional insured”. Failure to provide both of these documents at least 15 calendardays prior to the use of the District facility will result in the cancellation of the facility use permit. Currentpermit holders on file with the District must update their Certificates of Insurance annually. No reservationswill be accepted for any dates that fall outside the period of coverage.

By agreeing to the rental terms and conditions, all permit holders agree to defend, indemnify and holdharmless the District, its officers, employees and agents from and against any and all liability, cost, expense,claims, injuries, losses or damages, including damage to District property, which may result or arise in anyway out of the permit holder’s use or occupancy of the facilities, negligence of the permit holder group, itsofficers, employees or agents.

Once approved, permit holders will be sent a link. Once connected, permit holders may requestpermission to use the District’s online facilities system. Requests will be reviewed for approval the PUSDFacilities Comptroller.

Reservations can be made up to nine months in advance. No reservations will be accepted beyondnine months from the date of the request.

Once a permit holder has signed into the District’s online facilities system, permit requests may besubmitted online using the Facility Scheduling service.

Payments

The District will issue an invoice following the event and the monies are due and payable within 30 daysfollowing use unless otherwise agreed in a written MOU.

Consecutive permits and/or continuing permit uses will be billed monthly.

Checks should be made payable to Piedmont Unified School District. To facilitate processing, please besure to write the permit number on your check.

Per Piedmont Unified School District Board policy, new facility use permits will NOT be issued togroups with past due accounts. This policy will be strictly enforced.

The Piedmont Unified School District reserves the right to refer any delinquent account to a collectionagency and/or report to a credit bureau. Legal proceedings may be initiated for any delinquent account.By reserving a permit, users agree that to pay the District’s legal costs incurred to seek payment of unpaidamounts owed by the group or organization.

Section 7: Applicable Policies and Other Requirements

Steroid/Tobacco Use Policy and Use of District’s Sport/Athletic FacilitiesThe governing Board of the Piedmont Unified School District has adopted Board Policy 5131.63 prohibiting

the use and abuse of androgenic/anabolic steroids, and Board Policy 3513.3 which prohibits the use of tobaccoproducts at all times on District grounds, including the use of nicotine delivery devices, such as electronic

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Deleted: Piedmont Unified SchoolDistrict Board Policy 5131.63: “Use ofsteroids to increase strength or growthcan cause serious health problems.

Deleted: Steroids can keep teenagersfrom growing to their full height; theycan also cause heart disease, stroke, anddamaged liver function.

Deleted: Men and women usingsteroids may develop fertility problems,personality changes, and acne.

Deleted: Men can also experiencepremature balding and development ofbreast tissue.

Deleted: These health hazards are inaddition to the civil and criminalpenalties for unauthorized sale, use, orexchange of anabolic steroids

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cigarettes. These prohibitions apply to all employees, students and visitors at any activity or athletic event onproperty owned, leased or rented by or from the district.

All organizations and/or individuals renting District facilities must abide by these policies. Violations will resultin the termination of the offender’s facility use permit(s). Should this occur, all necessary costs, includingcustodial fees, shall be forfeited to the District.

Damage Responsibilities of Permit Holders

Permit holders agree to the following:

Abide by and to enforce the rules, regulations, and policies of the Piedmont Unified School Districtgoverning the use of the school premises or equipment.

Defend, indemnify and hold harmless the District, its officers, employees and agents from and against anyand all liability, cost, expense, claims, injuries, losses or damages, including damage to District property, whichmay result or arise in any way out of their use or occupancy of the facilities, negligence of the user group, itsofficers, employees or agents.

Defend, indemnify and hold harmless the District, its officers, employees and agents from and against any and all liability, cost, expense, claims, losses, damages demands, suits, actions, payments and judgments,including legal and attorneys fees, arising from personal or bodily injuries, including death, or property damage orotherwise, however caused, sustained by any persons(s), firm(s), corporation(s), including the District, brought orrecovered against any of the above that may arise for any reason from or during or be alleged to be caused by theundersigned’s use/occupancy of District’s facilities, including school or District parking lots and walkways,furniture or equipment or other use as requested by the permit holder, or from any occurrence in or on thefacilities, and will further indemnify and hold the District harmless against and from any and all claims arisingfrom any breach or default on the part of the permit holder in the performance of any covenant or agreement onthe part of the permit holder to be performed pursuant to the terms of this use, or arising from any act ornegligence of the permit holder, or any of its agents, contractors, servants, employees, licensees, customers, orinvitees. In the case any action or proceeding is brought against the District by reason of any such claim, thepermit holder, upon notice from the District, covenants to resist or defend at permit holder’s expense such actionor proceeding by counsel reasonably satisfactory to the District. The term “facilities” as used in this agreementshall include any adjacent school or District parking lots, walkways or thoroughfares used by guests, patrons,invitees, employees, or agents of the permit holder.

The permit holder further agrees to retain responsibility for any loss, theft or damage to permit holder’sequipment, supplies or materials or equipment, supplies or materials of others brought onto or stored on District’spremises in connection with permit holder’s use of District’s facilities and premises. The permit holder furtheragrees to surrender the premises and facilities to the District at termination of the use period hereinbeforespecified in the same condition as at the commencement of the period. All equipment, supplies and materials ofany kind, used by the permit holder, shall be removed from the premises at termination of the use period.

Shall be liable for any damages to school property caused by the activity pursuant to the provisions ofPUSD Administrative Regulation 1330. The Board shall charge the amount necessary to repair any damages orprovide replacement of school property. Further use of school facilities may be denied the responsible party.

Furniture and Equipment

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The applicant is required to specify furniture and equipment needs on the Facility Use Application at the time theapplication is submitted. The following furniture and equipment is available to permit holders free of charge,depending on the facility requested: chairs, tables, speaker podium, projection screen and/or TV/VCR.

Custodial ServiceCustodial service is provided only for access, chair/table set-up, heating, lighting, ventilation, and clean-up of abuilding. This service does not include the erecting or dismantling of scenery, equipment, or other apparatus. Ifthe set-up and clean-up extend beyond 30 minutes, as determined by the Facilities Use Manager, PUSD willcharge an additional fee for custodial services (as noted in the Fee Schedule). Custodians open restrooms onlyduring regularly scheduled hours of operation.

Guidelines for Facility UseThe Piedmont Unified School District asks its user groups to help maintain the useful life of District facilities byobserving the checklists on the following pages.

Users should keep a copy of the permit at the facility throughout the event. In the unlikely event of a schedulingdispute, a copy of the permit will serve as confirmation.

Section 8: Guidelines for Facility Use

Classrooms, Auditoriums, Multipurpose Rooms, Theater, and Gymnasiums

DOAbide by all fire regulations Keep exit doors, exit lights, fire alarm stations, wet standpipe hose cabinets,

and fire extinguisher locations visible and unobstructed by decorativematerial or any other item. (C.A.C. Title 19, Sections 7.20).

Per state law, refrain from smoking on school property.

PUSD Board Policy prohibits use of tobacco products at all PUSD facilities.

Keep exit ways and required means of egress unobstructed so they may beused as an exit. (P.F.C. Section 26.107 and C.A.C. Title 19, Section 65.03).

Observe all parking signs and postedrestrictions

Parking is very limited at all of the school sites, as only street parking isavailable. All parking restrictions (noted by signs and painted curbs) arestrictly enforced by the Piedmont Police Department according to CaliforniaVehicle Code 21113(a) and applicable, city ordinances. Violators may becited.

Clean-up Clear the entire facility of debris and thoroughly clean all areas.

Clean the kitchen and leave everything in working order. Place garbage anddebris in cans provided or in additional plastic bags supplied by the custodian.

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Deleted: Clean the stove, removing allgrease, drippings, and burn marks.¶

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DO NOTDeface facility walls and surfaces by …using scotch tape, masking tape, or adhesives on any surface.

…driving nails, hooks, or tacks into any surface. …affixing anything to walls, windows, doors, woodwork, curtains, beams,

ceilings, chandeliers, or pieces of furniture. …using acids, dyes, solvents, paint pigments, rubber-backed mats, or rubber

casters. …consuming food in the Beach Auditorium or Wildwood Auditorium …SMOKING OR CONSUMING ALCOHOLIC BEVERAGES ON

SCHOOL PROERTY, in accordance with state law.

Sports Fields

DORespect the neighbors when using ourfacilities

Lights must be turned off not later than 9:00 p.m.; lights are not permitted onSundays.

Lights may not be turned on before 6:30 a.m.

The Witter Field Complex is CLOSED for use by the public during schoolhours.

Commercial use is prohibited.

Organized and/or commercial use may include but is not limited to activitieswith identified teams, or individuals, groups with uniforms, coaches, trainers,referees, presence of spectators, and equipment (such as goal posts, any kindof amplification system/equipment).

All users are expected to be respectful of each other, the facility and theneighbors.

If more than one group wants to use the field, it is expected that groups willshare.

The track area is reserved for individual casual joggers only.

No organized Sunday is allowed use unless a permit is issued

The El Cerrito access gate will be locked on Saturdays at 5:00 p.m. andremain locked until Mondays at 6:00 a.m.

Park in designated parking areas anddrive carefully

In accordance with Section 21113(a) of the California Vehicle Code.

Observe all parking signs and posted restrictions.Place garbage and debris incans provided or in additional plastic bags supplied by the custodian.

Follow the guidelines set forth in thepermit

Contact the Facilities Use Manager to obtain a permit for an organized event.

Abide by the hours posted and approved for the group’s facility use permit.

Keep a copy of the facility use permit with on hand in the event a conflict inscheduling or use is questioned.

Stay in the stands if you are a spectator.

Protect the field and track surface Wear proper athletic/running shoes on the track

No cleats, heels, or dress shoes on the track

Keep vehicles on the pavement.

Clean up litter generated by activity, including any litter left by spectators.

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DO NOTAllow any of the following to occur… Damage the track surface by allowing dogs, bicycles, skateboards, and

vehicles on the fields or track. Bring pets to the Witter Field Sports Complex or Havens Playfield. Dogs

accessing Piedmont Park must be on a leash at all times. Allow food, beverages, or pets on the track or main football/soccer field. Use any kind of portable public address system equipment Use or access the baseball or softball fields when closed to allow for seasonal

field rest and regrowth of grass.

Note: The Witter Field House restrooms are open weekdays from 3:30 – 9:00 p.m. Upon request, restrooms areavailable for organized groups on weekends for a daily flat rate as noted in the Fee Schedule.

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PENDING REVISION

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24-7 UK Soccer Academy

510 Sports

ALTB INLT , Inc

American Cancer -Relay For Life; Oakland

American Cancer Society

American Constitution Society

Ant's Mind and Body

Aspire Education Project

Associated Parents Club of Piedmont

Avid4 Adventure

Baja Piedmont Citizens

BARRACUDAS

Bay Area Bandits

Bay Area Children's Theatre

Bay Area Lady Warriors (BALW)

Bay Area Track Club

Bay Oaks Soccer

Beach (BPO)

Beach Elementary School

Berkeley Blaze

Berkeley Chess School

Berkeley RFC

Blackett

BoEsRa Watch Group

Boy Scouts - Fencing Crew

Boy Scouts - Piedmont Council

Boy Scouts Troop 4

Brazzissimo

Brian Gardere

Brownie Troop #33431

California Virtual Academy

Catalyst Prep

Childrens Hospital Oakland

CHIME

Christelle Hutin

CommStrat

Community Interface Research

Comptroller

Concordia University Irvine

Corpus Cristi School

Cotteco

CSEA

Cub Scouts Pack 3

Cub Scouts Pack 4

Cub Scouts Pack 4/Piedmont Council BSA

Davis Hoops Basketball Club

PUSD District Office

Diversity Film Series

PUSD Rental Organizations

Eagleview Foundation

East Bay Fit Club

East Bay Flag Football

East Bay Goaltimate

East Bay Ports

East Bay Youth Band

East Bay Youth Sports

EBOTS

Edu Culture International

Education Speaker Series

Education Unlimited

Eshun Family

Family Fitness Now

Fitness Foundation

Foothill Force Jump Rope Team

french bilingual tutoring

Future Star Baseball

Gadung Kasturi Balinese Dance & Music Inc.

George Mark Childrens House

Ger Youth Center

Girl Scouts

Glass and Marker, Inc

Gold Bombers

Golden Bear Volleyball Club

Grand Canyon University

Greater Bay Area Costumers Guild

Half Moon Films, LLC

Havens Elementary School

Hip Wah Summer Program

Holy Names High School

Holy Names University Athletics

IMAAHE

Inner Athlete

Inside Track

JCC of the East Bay

Jewish Teen Mentorship Program

Julie Friedkin

Kaia F.I.T.

Keith Roberts--Parent

Kids Love Writing

Kids Take the Stage

League Of Women's Voters

Leukemia & Lymphoma Society (Team in Training)

LLL Lightning Lacrosse

LMJS

Mighty Mites

Mike Vax Big Band

Millennium High School

Mills College APER Department

NABA

National Charity League

NCAKE

NCL

Nicole - D.O.

Nike Inc.

NorCal Lacrosse

North Oakland Little League (NOLL/SOLL)

Northern California Association of Kodaly Educators

Oakland Hebrew Day School

Oakland Triathlon Club

Oaks Baseball

O'Connor

PAC West

Pacific West Athletics

PAINTS

Patriots Baseball

Paul Hunt

Peer Advisors

PHS Boys Water Polo

PHS Boosters

PHS Football

PHS Lacrosse

PHS Swim team

PHS Volleyball

PHS Women's Basketball

Piedmont Adult School

Piedmont ALPS

Piedmont Appreciating Diversity

Piedmont Asian American Club (PAAC)

Piedmont Ballet Academy

Piedmont Baseball Softball Foundation

Piedmont Basketball Foundation

Piedmont Boy Scouts

Piedmont Choirs

Piedmont Dads Boot Camp

Piedmont Educational Foundation

Piedmont GPS

Piedmont High School

Piedmont High School Baseball Program

Piedmont Highlanders Pipes

Piedmont Lacrosse Association

Piedmont Language School

Piedmont Makers

Piedmont Middle School

Piedmont Parent Network

Piedmont Police Dept.

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Piedmont Recreation Department

Piedmont Rugby

Piedmont Soccer Club

Piedmont Tornados

Piedmont Waterpolo

Piedmont Youth Bagpipe Band

PITS Rugby

PITS Rugby (girls)

Playback Theater

PMS 7th Grade Dance Class

PMS Parents club

Polka Dot's dance

PRAISE

Prince Charles Band/Piedmont Youth Band

Princeton Review

Private Piedmont Parent

Project Equilibria

Purple Reign

PUSD District Office

PUSD Wellness Center

Rakers baseball

Registrar of Voters

Relay For Life; Oakland

Road Runners Club of America

RUN365

San Francisco Paramedic Association

Scicluna Soccer

See Jane Run

SF Marathon

SF Seals

Sharlyns Dance

Sherry Sports, LLC

Sherry Sports/Bearlax Club

Skyline Lacrosse

Soccer Shots

Soccerfours

Spring Fling

St. James Wood Homes Association

St. Lawrence O'Toole Catholic School

Stage Door Conservatory

Steubenville Media West

Study Smarter

Super Star Literacy

Tahoe Back Country Ski Patrol

Team Challenge - Crohn's and Colitis

The Inner Athlete

The Leukemia and Lymphoma Society

THE MUSE COMPANY

The Present Body

The Princeton Review

The Wright Insititute

Thrashers Soccer team

Triple Threat Academy

US Census Bureau

Twelve Step Program

USA Ultimate

Velocity Baseball

Viola's Notes

VisionTech Education

Wellness Center Steering Committee

West Coast Fantasy Baseball Association

WFA - L Cheung

Wildwood Elementary School

Wildwood Girls Scouts

Wildwood School Dads Club

Wildwoods Parents Board

Xceleration Volleyball

YBA Your Basketball Association

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Page 1 of 1



FROM: Constance Hubbard, Superintendent

SUBJECT: Draft 2015-16 Board Meeting Schedule

______________________________________________________________________


The Piedmont Unified School District Regular Board Meetings are scheduled on thesecond and fourth Wednesdays of the month when possible. The school district isorganized as part of the City of Piedmont Charter. At the election in November2014, the community approved a change to the City Charter to hold elections forthe City Council and the School Board in November of even number years startingin November of 2016. The change from a special election in February of even yearsextends the terms of the current Board Members from February 2016 to Novemberof 2016. The amendment approved also included language to allow the schedulingof School Board meetings and the reorganization of the Board of Education to be inkeeping with the rules and regulation of California Education Code. The CityCharter previously required that the Board of Education hold its annualreorganization meeting for the purpose of electing a President and Vice Presidentno later than July 15 of each year and after an election (in February on evennumbered years).

The City Charter now provides the flexibility for the Board not to hold a meeting inJuly if there is no business requiring a meeting. It also allows for the Boardreorganization meeting to be scheduled annually in December per Education Coderequirements. The reorganization meeting in December is in keeping with mostdistricts in California.

The attached draft list of Board meeting dates with some of the key agenda itemslisted. There are some alternative dates the Board can discuss during months whenthe second and fourth Wednesdays are not available.

The Board is requested to review the schedule and provide staff with direction. Theschedule will be brought back for discussion and approval at the next meeting. TheBoard may revise the Regular Board Meeting schedule at any time during the yearby action at a Board Meeting prior to the change.

II. RECOMMENDATION: REVIEW AND ACTION

Review and provide direction to the staff for 2015-16 Regular Board Meetingschedule.

CH/ss

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1

PIEDMONT UNIFIED SCHOOL DISTRICT

Schedule of Regular Board of Education Meetings2015-16

Regular Board of Education meetings listed below are held on thesecond and fourth Wednesdays of each month, unless otherwise noted,and are held in the Council Chambers of the City Hall, 120 VistaAvenue, Piedmont, beginning at 7:00 p.m.

July 2015

No meeting is required and no issues anticipated at this time

August 26, 2015

Revised 2015-16 District budget to be presented based on theState Adopted Budget.

September 9, 2015

Approval of the 2014-15 Unaudited Actuals

Review of Sufficiency of Instructional Materials

September 30, 2015*

October 14, 2015

October 28, 2015

November 10, 2015**

December 9, 2015

Conduct annual reorganization meeting to elect Board President andVice President

Review of 2015-16 First Interim Report

January 13, 2016

Accept Independent Audit Report for 2014-15

January 26, 2016***

February 10, 2016

March 9, 2016

Review of the 2015-16 Second Interim Report

IF required - deadline: Certificated layoff, release oftemporary/probationary employees or notice of possiblereassignment of administrators/APSA classified employees

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2

March 23, 2016

April 6, 2016 OR April 27 Due to Spring Break April 11-13 only onemeeting

Public Hearing for levy of the 2016-17 School Support Tax

May 11, 2016

May 25, 2016

June 8, 2016

Review of revised 2016-17 LCAP

Review of proposed 2016-17 Adopted Budget

June 22, 2016

IF Board approves a bond measure for November 2016election, all required resolutions and ballot language to beapproved to meet Registrar of Voters timeline for ballot

*Meeting is being held on the fifth Wednesday of the month

**Meeting on Tuesday due to Veterans Day on Wednesday

***Meeting on Tuesday to enable Superintendent to attend AnnualSuperintendent’s Symposium

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SUBJECT: APPROVE CERTIFICATED ASSIGNMENT BY WAIVER


The California Commission on Teacher Credentialing provides the option ofassigning teachers by waiver when a district is unable to employ a teacherwho holds the appropriate credential. This avenue is most commonly usedin recognized teacher shortage areas such as Mandarin, advancedmathematics, and special education.

It is recommended that the Board approve Hanning (Iris) Zheng as a .2FTEMandarin A teacher at Piedmont Middle School. Ms. Zheng earned herMaster’s degree from Middlebury College in Vermont in Teaching Chineseas Foreign Language in 2014. She has recent experience in teachingMandarin at the Urban School in San Francisco, California as a substitutefor a semester for a teacher who was on sabbatical. In order to process anemergency credential, I am requesting that the Board authorize a waiver forthe CBEST test requirement. Ms. Zheng is scheduled to take the test at thenext administration in March 2015. We are very fortunate to have a nativespeaker with teaching experience to take on this part-time assignment atPiedmont Middle School and I recommend approval of this requirement.

II. RECOMMENDATION: REVIEW AND ACTION

Accept recommendation of Superintendent to approve certificatedassignments by waiver for Hanning (Iris) Zheng to teach Mandarin A for twoclasses for the Spring 2015 semester at Piedmont Middle School.

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PIEDMONT UNIFIED SCHOOL DISTRICTPiedmont, California

January 27, 2015

TO: Members of the Board of Education


SUBJECT: Personnel Action_____________________________________________________________________________

SUBJECT TO BOARD APPROVAL

Employment: CertificatedCarolina Zamorano Spanish Teacher PMSEffective 1/20/15 .6 FTE Temporary

Hanning Zheng Mandarin Teacher PMSEffective 1/20/15 .2 FTE Temporary

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PIEDMONT UNIFIED SCHOOL DISTRICTBoard Policy

Business and Noninstructional Operations BP 3513.3

TOBACCO-FREE SCHOOLS

The Board of Education recognizes the health hazards associated with tobaccoproducts, including the breathing of second-hand smoke from cigarettes or electronicsmoking devices, and desires to provide a healthy environment for students and staff.Employees are encouraged to serve as models for good health practices that areconsistent with the district's instructional programs.

In accordance with state and federal law, smoking is prohibited in all district facilities andvehicles. (20 USC 6083; Labor Code 6404.5; Health and Safety Code 104495)

(cf. 5131.62 - Tobacco)(cf. 6142.8 - Comprehensive Health Education)(cf. 6143 - Courses of Study)

The Board further prohibits the use of tobacco products and electronic smoking devicesat all times on district grounds. This prohibition applies to all employees, students andvisitors at any activity or athletic event on property owned, leased or rented by or fromthe district.

The Superintendent or designee shall inform students, parents/guardians, employeesand the public about this policy and related procedures.

(cf. 4118 - Suspension/Disciplinary Action)(cf. 4218 - Dismissal/Suspension/Disciplinary Action)(cf. 5144.1 - Suspension and Expulsion/Due Process)

Signs prohibiting the use of tobacco and electronic smoking devices shall be prominentlydisplayed at all entrances to school property.

The Superintendent or designee shall maintain a list of clinics and other resources whichmay assist individuals who wish to stop using tobacco products.

Legal Reference:EDUCATION CODE48901 Smoking or use of tobacco; steps to discourageHEALTH AND SAFETY CODE39002 Control of air pollution from nonvehicular sources104420 Implementation of tobacco use prevention programLABOR CODE6404.5 Occupational safety and health: use of tobacco productsUNITED STATES CODE, TITLE 206083 Nonsmoking policy for children's servicesCITY OF PIEDMONTOrdinance 715 N.S.

Adopted: January 12, 2000Revised: January 27, 2015

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PIEDMONT UNIFIED SCHOOL DISTRICTAdministrative Regulation

Business and Noninstructional Operations AR 3513.3

TOBACCO-FREE SCHOOLS

Employee Notifications

The Superintendent or designee shall notify employees of the district's tobacco-freeschools policy. The notification shall also inform them of:

1. 1. Their need to abide by District policy as a condition of employment.

1. 2. The dangers of tobacco use in the workplace, including its threat to the healthand safety of employees, students and the public.

1. 3. Available resources which may help employees stop using tobacco.

1. 4. Possible disciplinary actions in accordance with Board policy, state law andapplicable collective bargaining agreements.

a. 1. Enforcement Procedures for Visitors

a. 2. A visitor who smokes on district property shall be informed of the District'stobacco-free schools policy and asked to refrain from smoking. If the person fails tocomply with this request, the following actions may ensue:

1. 1.The matter may be referred to the Superintendent or designee responsible for thearea or the event.

1. 2.The Superintendent or designee may direct the person to leave school property.

1. 3.If necessary, the Superintendent or designee may request local law enforcementassistance in removing the person from school premises.

1. 5. If the person repeatedly violates the tobacco-free schools policy, theSuperintendent or designee may prohibit him/her from entering district property fora specified period of time.

(cf. 1250 - Visitors/Outsiders)(cf. 3515.2 - Disruptions)

Approved: January 12, 2000

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Piedmont Unified School DistrictBoard Policy

BP 4112.4 Personnel

HEALTH EXAMINATIONS

New Employees

No persons shall be employed initially unless he/she has submitted to a tuberculosisexamination within the past sixty days to determine whether he/she is free from active

tuberculosis. A person shall not be initially employed by a school district, or employedunder contract, in a certificated or classified position unless the person has submitted toa tuberculosis risk assessment developed by the CDPH within the past 60 days and, iftuberculosis risk factors are identified, has been examined to determine if s/he is free ofinfectious tuberculosis by a physician, surgeon, nurse practitioner, or physician’sassistant.

1. The tuberculosis examination shall consist of either an approved intradermaltuberculin test or an x-ray of the lungs. If no risk factors are identified an examination isnot required.

2. After the examination, each employee shall place on file with the district a certificatefrom the examining physician showing that the employee is free from active tuberculosis.Persons who have not complied with the provisions of this policy shall not be allowed toteach in any school of the district. If risk factors are identified the identified individualshall submit to an approved intradermal tuberculin test or other tests for tuberculosisinfection that is recommended by the CDC and FDA. If the Test is positive, the test shallbe followed up by an X-ray of the lungs by a qualified X-ray technician.

3. Persons transferring from another district shall fulfill the requirements of this policy byeither:

a. Producing a certificate showing that the employee was examined within the last fouryears and found free of active tuberculosis,

b. Having the last employing school verify that a current certificate is on file,

c. Undergoing the tuberculosis examination.Postponement of tuberculosis testing and X-rays related to pregnancy and pregnancytermination may be extended for 60 days following the pregnancy termination.

4. The Board of Education shall follow provisions of Education Code 49406 (g) in thosecases where employee's religious belief prevents them from undergoing a physicalexamination. Employees who have no identified risk factors or who test negative fortuberculosis infection shall be required to undergo tuberculosis risk assessment onceevery four years.

5. Employees who test positive for tuberculosis, confirmed by an X-ray, no longer needto complete the tuberculosis risk assessment.

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6. After the negative tuberculosis risk assessment, the employee shall file with thedistrict superintendent of schools a certificate of completion developed by the CDPH orother TB clearance form from the provider.

7. A person who transfers employment from one school district to another shall bedeemed to meet the requirements if that person can produce a certificate of completiondeveloped by the CDPH or other TB clearance form from the provider that shows s/hewas found to be free of infectious tuberculosis within 60 days of initial hire. Additionallanguage about volunteers, pre-schools, private and parochial schools and secondaryeducation also have similar requirements.

All Other Employees

All employees of the district shall be required to undergo a chest x-ray or intradermal testat least once every four years. These examinations shall be provided by the district or atdistrict expense. (Education Code 49406)

Whenever the Superintendent has a probable cause to suspect that any certificatedemployee has any infectious, contagious of communicable disease, or any illness whichwould directly affect the health and welfare of students, he/she shall have the authorityto require a medical examination administered by a physician licensed under theBusiness and Professions Code. The cost of such examination shall be at the expenseof the district. (Education Code 44839, 5CCR, 5504)

Employees whose mental health is in question may be subject to review by a psychiatricpanel in accordance with Education Code 44942.

Employees may be required to pass a physical and/or psychological examination anytime such an examination appears necessary to preserve the health and welfare ofdistrict students and employees or to furnish medical proof of physical or mental ability toperform satisfactorily the assigned duties of an individual's position.(cf. 4119.41 - Employees with Infectious Disease)

Legal Reference:EDUCATION CODE44839 Medical certificate; periodic medical examination44839.5 Requirements for employment of retirant44932 Grounds for dismissal of permanent employee44942 Suspension or transfer of certificated employee on ground of mental illness,psychiatric examination; mandatory sick leave45122 Physical examinations49406 Examination for tuberculosisCODE OF REGULATIONS, TITLE 55502-5503 Physical examination for retirants employed as substitute teacher, etc.5504 Medical certification proceduresHEALTH AND SAFETY CODE121525-121555 Tuberculosis tests for employee

Adopted: February 9, 2000Revised: January 27, 2015

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Board Policy

Students BP 5131.6

DRUGS, TOBACCO, ALCOHOL

The Board recognizes that alcohol, drug and tobacco use present a health hazardwhich can have serious consequences for both the user and others who might relatewith the user. Therefore, the board is committed to a drug-, alcohol-, and tobacco-free school district.

Implementation and Enforcement Related to Drugs and Alcohol

It shall be the policy of the schools to take positive action through education,counseling, parental involvement, medical referral and police referral in the handlingof incidents in the schools involving the possession, use, sale or otherwise furnishingor being under the influence of any controlled substance, as defined in the Healthand Safety Code 11007, drug paraphernalia, alcoholic beverages or intoxicants ofany kind. These substances shall include but not limited to marijuana, LSD, glue,alcohol and barbiturates.Students involved in the possession, sale and/or use of behavior affectingsubstances as stated above shall be subject to disciplinary procedures which mayresult in suspension or expulsion.

(cf. 6164.11 - Drugs, Tobacco, Alcohol)(cf. 5144.1 - Suspension and Expulsion/Due Process)

School properties may be inspected by the school authorities in the interest ofmaintenance, health and safety. Inspections for the location of drugs, narcotics,liquor, weapons, poisons and missing properties are matters relating to health andsafety and may be regarded as reasonable purpose for inspection by schoolpersonnel; so long as such inspections are conducted in accordance withconstitutional requirements of applicable state law relating to searches and seizures.

(cf. 5145.12 - Search and Seizure)

Implementation and Enforcement Related to Tobacco

All individuals are prohibited from smoking cigarettes or using any other tobaccoproducts or electronic smoking devices on district property or in district vehicles. Thisapplies to all students, staff and visitors. This policy applies to all events on schoolproperty.

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Students shall not be allowed to smoke or possess tobacco or electronic smokingdevices on school property or during school hours. Students who violate this policyshall be subject to disciplinary procedures and may be subject to suspension.(Education Code 48900, 48900.5)

(cf. 5144 - Discipline/Punishment)(cf. 5144.1 - Suspension and Expulsion/due process)

Piedmont Unified School District shall make a good faith effort to provide a safe andhealthy tobacco-free environment to discourage tobacco usage by:

1. Posting signs prohibiting the use of tobacco products and electronic smokingdevices;

2. Notifying students and personnel regarding the district's tobacco policy;

3. Providing student instruction regarding the effects of smoking and electronicsmoking devices on the human body;

4. Making referrals to smoking cessation programs, if applicable.

The success of this policy will depend upon the thoughtfulness, consideration andcooperation of tobacco users and non-users. All staff, students and visitors share inthe responsibility for adhering to and enforcing this policy. Violation of the policy willresult in applicable discipline procedures.

Legal Reference:EDUCATION CODE44049 Known or suspected alcohol or drug abuse by student48900 Suspension or expulsion (grounds)48900.5 Suspension, limitation on imposition; exception48901 Smoking or use of tobacco prohibited48901.5 Prohibition of electronic signaling devices48902 Notification of law enforcement authorities; civil or criminal immunity48909 Narcotics or other hallucinogenic drugs48915 Expulsion; particular circumstances49423 Administration of prescribed medication49480 Notice to school by parent or guardian; consultation with physician49602 Confidentiality of pupil information51202 Instruction in personal and public health and safety51203 Instruction on alcohol, narcotics and restricted dangerous drugs51210 Areas of study51220 Areas of study, grades 7 to 1251260 Elementary and secondary school instruction in drug education byappropriately trained instructors51262 Use of anabolic steroids; legislative finding and declaration

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51264 CDE assistance for inservice training51265 Gang violence and drug and alcohol abuse prevention inservice51268 Collaboration to avoid duplication of effortBUSINESS AND PROFESSIONS CODE25608 Alcohol on school property; use in connection with instructionHEALTH AND SAFETY CODE11032 Narcotics, restricted dangerous drugs and marijuana; construction of termsused in other divisions11053-11058 Standards and schedules11353.6 Juvenile Drug Trafficking and Schoolyard Act11357 Unauthorized possession of marijuana; punishment; prior conviction;possession in school or on school grounds11361.5 Destruction of arrest or conviction records11372.7 Drug program fund; uses11802 Joint school-community alcohol abuse primary education and preventionprogram11965-11969 The School-Community Primary Prevention Program11998-11998.3 Drug and Alcohol Abuse Master Plans11999-11999.3 Alcohol and drug program funding; no unlawful use124175-124200 Adolescent family life program (Department of Health Services)PENAL CODE13864 Comprehensive alcohol and drug prevention educationVEHICLE CODE13202.5 Drug and alcohol related offenses by person under age of 21, but aged 13or over; suspension, delay, or restriction of driving privilegesWELFARE AND INSTITUTIONS CODE828 Disclosure of information re minors828.1 Disclosure of criminal records; protection of vulnerable staff & studentsUNITED STATES CODE, TITLE 205812 National education goals7101-7184 Safe and Drug-Free Schools and Communities ActCITY OF PIEDMONTOrdinance 715 N.S.

Adopted: July 5, 2000Revised: June 4, 1986Revised: December 13, 1995Revised: January 27, 2015

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Administrative Regulation

Students AR5131.6

DRUGS, ALCOHOL, TOBACCO

Intervention

The staff shall intervene whenever students use alcohol, or other illegal drugs,tobacco or other electronic smoking devices while on school property or underschool jurisdiction. Staff members who believe that a student may be under theinfluence of alcohol or drugs shall immediately notify the principal or designee.

If the principal or designee knows, observes or suspects that a student may beunder the influence of alcohol or drugs, he/she may notify the parent/guardian.(Education Code 44049)

However, school staff shall not disclose confidential information provided duringcounseling by a student 12 years of age or older. School counselors may report suchinformation to the principal or parent/guardian only when they believe that disclosureis necessary to avert a clear and present danger to the health, safety or welfare ofthe student or other persons living in the school community. They shall not disclosesuch information to the parent/guardian if they believe that the disclosure wouldresult in a clear and present danger to the student's health, safety or welfare.(Education Code 44049, 49602)

(cf. 5145.1 - Privacy)

In cases of medical emergency, the principal is authorized to call an ambulance toremove the student to a hospital. Parents/guardians will be notified of this action andshall be responsible for the incurred expenses.

(cf. 5141 - Health Care and Emergencies)

Enforcement/Discipline

Staff shall notify the principal or designee immediately upon suspecting a student isin possession of, selling, providing or using alcohol or other drugs.

When any student uses, possesses or sells alcohol or illegal drugs at school or whileunder school jurisdiction, the following shall result:

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1. Parent/guardian contact

2. Suspension or expulsion in accordance with law or Board policy

(cf. 5144.1 - Suspension and Expulsion/Due Process)3. Contact with law enforcement authority within one school day of the suspension(Education Code 48902)

In addition, the following actions may be taken:

1. Referral to an appropriate counseling program2. Transfer/alternative placement

3. Restriction from all extracurricular activities, including athletics, for the length ofthe semester or longer in accordance with the school activity code

(cf. 6145 - Extracurricular and Cocurricular Activities)

Approved: July 5, 2000Revised: January 27, 2015

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Board Policy

Students BP 5141.21

ADMINISTERING MEDICATION AND MONITORING HEALTH CONDITIONS

The Board of Education recognizes that students may need to take prescribed medicationduring the school day in order to be able to attend school without jeopardizing their health.When the district has received written statements from the student's physician andparent/guardian, designated personnel shall assist the student in taking the medication. Inaddition, upon written request, designated personnel may assist the student in monitoring,testing or other treatment of an existing medical condition. (Education Code 49423)

(cf. 3530 - Risk Management/Insurance)(cf. 5141.24 - Specialized Health Care Services)

Upon written request by the parent/guardian and with the approval of the student'sphysician, a student with an existing medical condition that requires frequent monitoring,testing or treatment may be allowed to self administer this service. The student shallobserve universal precautions in the handling of blood and bodily fluids.

(cf. 4119.43/4219.43/4319.43 - Universal Precautions)(cf. 5141.23 - Infectious Disease Prevention)

Anaphylactic Injections

The Board recognizes that some students have allergies of such severity that they mayrequire an emergency anaphylactic injection during the course of the school day.Parents/guardians who are aware of this foreseeable need may ask the district to provide

such injections in accordance with administrative regulations.

School staff who may be required volunteer to administer anaphylactic injections shallreceive training from qualified medical personnel. They will be authorized to administerthe injections in accordance with administrative regulations and will be affordedappropriate liability protection.

Every five years, or sooner as deemed necessary by the Superintendent, theSuperintendent shall review with the district school nurse the minimum standards oftraining for the administration of epinephrine auto-injectors that satisfy legal requirements.

(cf. 5141 - Health Care and Emergencies)

Legal Reference:EDUCATION CODE49407 Liability for treatment49408 Emergency information49414 General Powers – School Boards49423 Administration of prescribed medication for student49423.5 Specialized health care services

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49426 School nurses49480 Continuing medication regimen; notice

BUSINESS AND PROFESSIONS CODE2700-2837 Nursing, especially:2726 Authority not conferred2727 Exceptions in general

Adopted: July 5, 2000Revised: January 27, 2015

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Administrative Regulation

Students AR 5141.21


Before a designated employee assists in the administration of any prescribed medicationto any student during school hours, the district shall have: (Education Code 49423)

1. A written statement from the student's physician detailing the method, amount and timeschedules by which the medication is to be taken

2. A written statement from the student's parent/guardian requesting the district to assistthe student in taking the medication as prescribed by the physician,.

3. Pparents/guardians shall be asked to provide a properly labeled pharmacy bottlecontaining the name and telephone number of the pharmacy, the student's identification,name of the physician, and dosage and time of the medication to be given.

4. When a controlled substance is to be taken at school, the school nurse or designatedemployee shall count the number of pills provided along with one other employee or theparent/guardian at the time the medication is delivered to the school. The pill count shallbe placed at the top of the log. The pills shall be recounted at the time the parent/guardianretrieves them from the school. A list of controlled substances shall be provided to theschool by the district nurse.

The designated employee shall:

1. Be responsible for the medication at school and administer it in accordance with thephysician's indicated written orders instructions

2. Maintain a list of students needing medication during school hours, including the type ofmedication, times, and dosage

3. Maintain a log recording the student's name and the time and date when medicationswere given4. Keep all medications in a locked drawer or cabinet except as specified in 4.

4. Life saving medications i.e., Epi-pen, Glucagon, and Diastat shall be kept in a securearea, accessible to staff in case of an emergency.

5. Effective January 1, 2015, the district shall contract with a Physician or NursePractitioner to obtain a prescription for stock Epi-pen. At least one stock Epi-pen shall bekept at each school site. A notice to employees shall be sent at the beginning of eachschool year identifying the location of the site Epi-pen.

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Self-administrationStudents who need to take asthma medication prescribed by the physician during theschool day may carry and self-administer inhaled asthma medication if two requirementsare met:1. The school district must receive a written statement from the physician with thefollowing information:

a.The name of the medication;

b.How it is to be used;

c. Dosage;

d. Confirmation that the student is able to self-administer the medication.

2. The school district must receive a written statement from parent/foster parent/guardianwith the following information *:

e.Consent allowing the student to self administer his/her asthma medication;

f. Release allowing the school nurse or other designated school personnel to consult withthe student’s physician if questions or concerns arise;

g.Release absolving the school district and school personnel from civil liability if the self-administering student suffers an adverse reaction.

Written authorization from the student’s physician and parent/ guardian must be updatedannually or whenever the medication or procedure for taking it changes.

Anaphylactic Medications

1. Parents/guardians of students who may require emergency anaphylactic injectionsshall provide written permission for authorized staff to administer these injections. AnAuthorization to Administer Medication During School Hours form must also becompleted.2. Each year, school employees who volunteer to administer anaphylactic medicationsshall receive training in administering anaphylactic injections. Qualified medical personnelshall provide this training.3. The principal or designee shall schedule inservice meetings to:

a. Familiarize authorized staff with the prescribed medications and their locationb. Ensure that authorized staff are competent to administer anaphylactic injectionsc. Train all school personnel to recognize the symptoms of anaphylactic reactions

Physicians and parents/guardians of students who may require anaphylactic injectionsmay be invited to attend these meetings.

Emergency Medications for Hypoglycemia

1. Parents/guardians of students who may require emergency glucagon injections forhypoglycemia shall provide written permission for authorized staff to administer theseinjections. An Authorization to Administer Medication During School Hours form must alsobe completed.

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2. Each year, school employees who volunteer to administer glucagon shall receivetraining in administering injections for hypoglycemia. Qualified medical personnel shallprovide this training.3. The principal or designee shall schedule inservice meetings to:

a. Familiarize authorized staff with the prescribed medications and their locationb. Ensure that authorized staff are competent to administer glucagon injectionsc. Train all school personnel to recognize the symptoms of hypoglycemia

Physicians and parents/guardians of students who may require glucagon injections forhypoglycemia may be invited to attend these meetings.

Emergency Seizure Medications

1. Parents/guardians of students who may require emergency seizure rectal medicationshall provide written permission for authorized staff to administer diastat rectally. AnAuthorization to Administer Medication During School Hours form must also becompleted.2. Each year, school employees who volunteer to administer emergency seizuremedications shall receive training in administering rectal diastat. Qualified medicalpersonnel shall provide this training.3. The principal or designee shall schedule inservice meetings to:

a. Familiarize authorized staff with the prescribed medications and their location.b. Ensure that authorized staff are competent to administer rectal diastat.c. Train all school personnel to recognize the need for rectal diastat.

Physicians and parents/guardians of students who may require anaphylactic injectionsmay be invited to attend these meetings.

Designated Employee/District ResponsibilitiesThe school nurse or other designated school personnel shall:1. Administer or assist in administering the medication in accordance with the physician'swritten statement2. Accept delivery of medication from the student's parent/guardian, including recordingthe medication upon receipt3. Maintain a list of students needing medication during the school day, including the typeof medication, times and dosage, as well as a list of students who are authorized to self-administer medication4. Maintain a medication log documenting the administration of medication including thestudent's name; name of medication the student is required to take; dose of medication;method by which the student is required to take the medication; time the medication is tobe taken during the regular school day; date(s) on which the student is required to takethe medication; physician's name and contact information; and a space for daily recordingof medication administrationThe daily record shall contain the date, time, amount of medication administered, andsignature of the individual administering the medication.5. Maintain a medication record including the physician's written statement, theparent/guardian's written statement, the medication log, and any other writtendocumentation related to the administration of medication to the student6. Ensure that student confidentiality is appropriately maintained7. Coordinate the administration of medication during field trips and after-school activities8. Report any refusal of a student to take his/her medication to the parent/guardian

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9. Keep all medication to be administered by the district in a locked drawer or cabinet10. Communicate with the prescribing physician as needed regarding the medication andits effects11. Counsel school personnel as needed regarding the possible effects of the medicationon the student's physical, intellectual and social behavior, as well as possible behavioralsigns and symptoms of adverse side effects, omission or overdose.12. By the end of the school year, ensure that unused, discontinued and outdatedmedication is returned to the student's parent/guardian where possible or, if themedication cannot be returned, is disposed of in accordance with state laws and localordinances

Notifications

The Superintendent or designee shall inform all parents/guardians of the followingrequirements: (Education Code 49480)

1. The parent/guardian of a student on a continuing medication regimen from a non-episodic condition shall inform the school nurse or other designated employee of themedication being taken, the current dosage and the name of the supervising physician.

2. With the parent/guardian's consent, a school administrator or The school nurse maycommunicate with the student's physician regarding the medication and its effects in orderto safely carry out the provider’s order and may counsel school personnel regarding thepossible effects of the drug on the student's physical, intellectual and social behavior, aswell as possible behavioral signs and symptoms of adverse side effects, omission oroverdose.

Anaphylactic InjectionsEpi-pen, Glucagon, and Diastat

1. Parents/guardians of students who may require emergency anaphylactic injectionsshall provide written permission for authorized staff to administer these injections.

2. Each year, school employees who volunteer designated by the principal shall receivetraining in administering anaphylactic injections. Qualified medical personnel shall providethis training. Notification of Volunteer Agreement for Training for Administration ofEpinephrine Auto-Injector, Diastat, and Glucagon shall be sent to school employees atleast once every year.

Before a designated employee assists in the administration of any prescribed medicationto any student during school hours, the district shall have: (Education Code 49423)

1. A written statement from the student's physician detailing the method, amount and timeschedules by which the medication is to be taken

2. A written statement from the student's parent/guardian requesting the district to assistthe student in taking the medication as prescribed by the physician

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Parents/guardians shall be asked to provide a properly labeled pharmacy bottlecontaining the name and telephone number of the pharmacy, the student's identification,name of the physician, and dosage of the medication to be given.

The designated employee shall:

1. Be responsible for the medication at school and administer it in accordance with thephysician's indicated instructions

2. Maintain a list of students needing medication during school hours, including the type ofmedication, times, and dosage

3. Maintain a log recording the student's name and the time and date when medicationswere given

4. Keep all medication in a locked drawer or cabinet

Approved: July 5, 2000Revised: January 27, 2015

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PIEDMONT UNIFIED SCHOOL DISTRICTExhibit

Students E 5141.21


Physician's Recommendations For Medication

This form is to be filled in and signed by a licensed physician. The form should then besigned by the parents/guardians and returned to the school.

Student's Name _______________________________________________________Last First Middle

Age _________________________________________________________________Birth Date Month Day Year

Name of School _______________________________________________________

Name of Principal ______________________________________________________

Name of Teacher ______________________________________________________

Type of Class_________________________ Grade___________________________

The law allows any person to assist in carrying out a physician's recommendation. Theschool recognizes the desirability of following physician's recommendations as nearly aspossible at school, just as does a parent at home or any other person (not necessarily anurse) if the physician requests his/her assistance. The fact that this is a service oraccommodation which the school is not legally required to perform is recognized by allparties signing this form, and in so signing they agree to hold the district, its officers,employees or agents, harmless from all liability, suits, claims of whatever nature or kindwhich might arise out of these arrangements.

Do you wish this child to receive medication at school? ______ YES ______ NO

If yes, please fill in the following blanks:

Form Observed or Assisted

(tablet, pill, Number to Approximate by Whom (self, teacher,

Name of Medication capsule, etc.) be Taken Time of Day nurse, etc.)

#1. ______________________________________________________________#2. ______________________________________________________________

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Precautions, if any ___________________________________________

How is medicine to be brought to school:_______________________________

By whom (student, parent, etc.)?_________________________________________

How often (daily, weekly, etc.)?__________________________________________

In what kind of container (envelope, bottle, plasticcontainer)?______________________________________________________________

Does the physician wish to be able to talk briefly by telephone with someone (teacher,nurse, principal, psychologist) at _____________ intervals (weekly, monthly, quarterly) tosee how this child is faring? If so, indicate:

Person(s)_______________ and intervals______________________________, andyou will be notified as to numbers and times at which the person(s) may usually bereached at school by telephone.

IMPORTANT: Please discontinue this request as of the following date.__________________________________________________________________Month Day Year

After this date, changes or continuance of these arrangements must be secured by fillingout a newly dated copy of this form._________________________________________________________________Signature_________________________________________________________________Address Telephone No. Date

License______________________________________________

MD. No. ______________________________________________

Physician Mo/Day/Yr__________________________________

___________________________________________________________Parents' or Guardians' Full Name Mo/Day/Yr

____________________________________________________________Parent's or Guardian's Full Name Mo/Day/Yr

Background Information

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LEGAL PROVISIONS

The purpose of allowing medication to be given to students by authorized schoolpersonnel is to help provide for their general welfare by following the instructions of theirphysicians. This position is clarified by the intent seen in the following sections from theNursing Practice Act (Chapter 6 commencing at Section 2700) Division 2 of the Businessand Professions Code):

NURSING OR MINISTRATIONS NOT PROHIBITED BY CHAPTER

"The performance by any person of such duties as required in the physical care of apatient and/or carrying out medical orders prescribed by a licensed physician: provided,such person shall not in any way assume to practice as a professional, registered,graduate or trained nurse." (Business and Professions Code Section 2727 (e).

PRACTICES UNAUTHORIZED

"This chapter confers no authority to practice medicine or surgery." (Business andProfessions Code 2726)

SUGGESTIONS FOR SCHOOL PROCEDURES

The procedures covering medication brought to school to be taken by students accordingto the provisions listed on the preceding form will be expedited if the following proceduresare used:

1. Two copies of the form are supplied: one for the school files and one for the personauthorized to administer the medication.

2. Only medication prescribed by the student's physician provider as being necessary tobe taken by the student in the manner listed on this form should be brought to school.

3. Such medication should be taken by the student in accordance with instructions fromthe physician listed on this form.

4. Medication brought to school to be given to the student according to the provisionslisted on this form should be in containers which are clearly marked with the name of thestudent; the name of the prescribing physician; an identification number or name of themedication; the druggist who dispensed the medication or the manufacturer; and theamount of medication to be taken at specified times or in specific situations.

5. All medications should be kept in a secure place. Any special instructions for storage orsecurity measures of any medication should be written by the physician and given toschool personnel so that such instructions can be followed.

Exhibitversion: July 5, 2000

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sspiker

Text Box

Version: January 27, 2015


Board Policy

Students BP 5141.24

DIABETES

The Board of Education of the Piedmont Unified School District is committed tomaximizing students' academic performance and physical wellbeing in a healthy andsafe environment. The district recognizes that diabetes is a manageable chroniccondition that if poorly controlled can be dangerous, impacting the student's health andability to learn. Diabetes is a condition on the rise in children and requires coordinatedmanagement in the school setting.

The district defines a healthy and safe environment as one in which adults work togetherto provide the following environmental factors established by current research asnecessary for the health and wellbeing of students with diabetes:

Educating staff, students, and parents/guardians about diabetes type 1 and type2

Establishing management and support systems for students with diabetes

The goals of providing a healthy and safe environment for students with diabetes are to: Maximize academic performance Maximize participation in all areas of school curriculum and extra-curricular

activities Minimize complications of diabetes Minimize absence due to diabetes related causes

The goals of providing staff with thorough training in providing a healthy and safeenvironment for students with diabetes are to:

Assure effective response in case of diabetes-related emergency Minimize classroom disruption

Legal Reference:

EDUCATION CODES33308.5 Program Guidelines49414.5 Medical Assistance to Pupils with Diabetes49423 Assistance in Taking Prescribed Medication49423.6 Administration of Medication51890 Comprehensive Health Education Programs51913 Plan for a Comprehensive Health Education Program51920 Inservice Training

FEDERAL LAWSection 504 of the Rehabilitation Act of 1973The Americans with Disabilities ActIndividuals with Disabilities Education Act

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UNITED STATES CODE, TITLE 291904 and 1910

STATE LAWBUSINESS AND PROFESSIONS CODES2700-2837 Nursing, especially:2726 Authority not conferred2727 Exceptions in general

ADDITIONAL REFERENCESNational Association of Nurses Position Statement: Nurse Role in Care andManagement of the Child with Diabetes in the School Setting. Adopted: November, 2001California School Nurses Organization Position Statement: Insulin Administration atSchool. Revised July, 2002Institute of Safe Medication PracticesAmerican Diabetes Association

Adopted: January 27, 2014

Page 48 of 57

PIEDMONT UNIFIED SCHOOL DISTRICTAdministrative Regulation

Students AR 5141.24

DIABETES

It is the goal of the Piedmont Unified School District that students attend school andreach their potential. The district is aware that the incidence of diabetes is rising in thestudent population. Complications related to diabetes may interfere with studentachievement. To that end, the district will:

1. Educate Staff, Students, and Parents/Guardians about Diabetesa. Ensure that any school nurse(s), registered nurses, and/or nursing

students be provided professional development training on diabetes, atwhich time they will receive appropriate curriculum for training staff,students, and parents/guardians.

b. Ensure that all staff be provided with in-service training updated annuallyby a nurse or other educator who has had diabetes training.

c. Provide a brief written summary including basic diabetes facts and thedistrict policy regarding diabetes management and administration ofinsulin to parents/guardians of children with diabetes upon registrationand at the beginning of each school year.

d. Provide schools with information regarding emergency management ofdiabetes to post in designated locations.

e. The principal of each school that has one or more students who havebeen diagnosed with diabetes shall ensure that provision is made for theschool nurse or other nurse trained in Diabetes Management to educatethe full staff about diabetes as soon as possible in the school year or assoon as possible after students are identified.

f. The principal shall designate at least three staff at the school site to betrained in the care of students with diabetes.

2. Establish Management and Support Systems for Students with Diabetesa. The school nurse will coordinate the District's diabetes-related activities.b. Identify students who have diabetes by including relevant questions on

the Student Emergency Card.c. Provide copies of the district health forms to be completed related to

diabetes to Parents/guardians of children with diabetes upon registrationor receipt by the school of the completed emergency card, at thebeginning of each school year, or upon diagnosis of diabetes. TheDiabetes Medical Management Plan completed by the child's physicianwill be kept on file in an accessible location in the school with a copy inthe student's cumulative file.

d. Provide a list of students identified with diabetes to the school nurse eachyear and update the list as needed.

e. Ensure that students with diabetes may carry and self-administer insulinwith signed release by a parent/guardian and medical provider.

f. A plan for management of blood glucose testing, administration of insulin,and any other accommodations necessary for the safety and well-being ofthe student with diabetes will be developed using a 504, IndividualizedStudent Healthcare Plan (ISHP), or IEP as appropriate in collaborationwith the student, parents/guardians, and staff at the school. The School

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Nurse or other nurse with training in diabetes will coordinate themanagement plan.

g. All supplies shall be kept labeled and dated in a location readilyaccessible to the student, brought on field trips, and included inemergency evacuations.

3. Provide for Blood Glucose Monitoring in the schoola. Blood Glucose Monitoring shall be implemented according to the Medical

Management Plan provided by the physician and identified in the 504,ISHP, or IEP.

b. Ensure that each school have at least three volunteer staff members, whoreceive training in the testing of blood sugar for students with diabetes bythe school nurse diabetes specialist or other nurse who has had diabetestraining.

c. Parents/guardians will be notified as appropriate according to theagreements in the 504, ISHP, or IEP.

4. Provide for Glucagon Administration in the schoola. Glucagon shall be administered according to the Diabetes Medical

Management Plan provided by the physician and identified in the 504Plan, ISHP, or IEP.

b. Only identified school staff who have been trained by the school nurse orother nurse with training in diabetes may administer glucagon.

5. Provide for Administration of Insulin in the schoola. Insulin shall be administered according to the Medical Management Plan

provided by the physician and identified in the 504, ISHP, or IEP.b. Insulin provided by the parents/guardians will be kept labeled and dated

in a location readily accessible to the student, brought on field trips, andincluded in emergency evacuations.

c. Insulin has been identified as a "high risk" medication, and shall beadministered by a licensed nurse, physician, parent/guardian, or parentdesignee who is not employed by the district. Additionally, a student mayself-administer insulin when authorized by his/her parent and physician,and after the physician has verified the student's competency to self-injectand dispose of supplies.

d. Authorization:i. The student's physician or nurse practitioner must complete a

Diabetes Medical Management Plan to be followed in the district.ii. Insulin administration orders must be renewed when there is a

change in the student's health status or dosage.iii. All physician orders/authorizations must be dated and in written

form, and include physician's name, address, phone/fax numbers,and signature.

iv. The Diabetes Medical Management Plan must be reviewed andsigned by the parent/guardian and include a Release ofInformation.

v. Authorization must be renewed when there is a change in thestudent's health status or dosage.

vi. Parents/guardians are responsible for informing the district of anychange in information related to the child's diabetes.

vii. Standing daily insulin regimen may be withheld when requestedby parent in writing, or by telephone when confirmed by a nurse

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and site administrator. Documentation of requests to withholdtreatment must be filed in the student's Diabetes ManagementBinder.

viii. Parent/guardian will be contacted immediately if student refusestreatment by school staff.

e. Parent/Guardian is responsible for all supplies and sharps disposal.

Injection Supplies: Must include alcohol wipes, insulin, insulin syringes,and sharps container. Insulin must be in a pharmacy labeled container,and only unexpired and unopened vials of insulin may be brought toschool. Once opened the insulin vial will be dated by the nurse and keptno longer than 30 days. Insulin syringes must be stored in a locked area.Safety syringes may be used when insulin is administered by a schoolnurse or other licensed nurse; if safety syringes are used they will beprovided by the district.

General Supplies: Must include glucometer and testing equipment, aswell as quick-acting glucose source and snacks, and Glucagon foremergency use per medical orders.

f. Record keeping and documentation

The student's Diabetes Management Binder will be kept in the classroomor front office. All documentation must be filed in the student's HealthFolder in the Cumulative Folder at the end of the school year. Thestudent's Diabetes Management Binder shall contain the:

i. 504, ISHP, or portion of the IEP related to Diabetesii. Emergency Contactsiii. Diabetes Medical Management Planiv. Procedure Guidelinesv. Diabetes Log

A copy of the Diabetes Log will be given to the student'sparent/guardian when necessary or requested by theparent/guardian.

g. All teachers who instruct the student and trained staff (e.g.,administrators, clerical/office staff) will be given information regardingdiabetes emergencies and signs and symptoms of hyper/hypoglycemiaby the School Nurse or other nurse who has received diabetes training.

Staff will follow Universal Precautions to maintain needle stick safety.

h. The school nurse or other nurse with diabetes training will:i. Assess student and confirm blood glucose results, review

physician's orders and collect necessary supplies - verify insulinvial has not expired, and administer insulin as needed.

ii. Document insulin administration in the Diabetes log andcommunicate such information to the parent/guardian as agreed inthe 504, ISHP, or IEP.


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Board Policy

Students BP 5141.26

Tuberculosis Testing

The Board of the Piedmont Unified School District is committed to maximizing students'academic performance and physical wellbeing in a healthy and safe environment.

The Board recognizes that tuberculosis poses a public health threat. Identification andtreatment of active cases of this disease is the most effective means of controlling itsspread.

The County Public Health officer requires that each child be evaluated for tuberculosisinfection and follow-up if appropriate, prior to initial school entry in PUSD.

Education Code 48211 provides that the Board may exclude children suffering fromcontagious or infectious diseases. Health and Safety Code 121485-121505 provides forthe exclusion of children reasonably suspected of having active tuberculosis.

The Superintendent and the School Nurse may require a health exam and a tuberculosistest when qualified medical personnel reasonably suspect that a student is at risk fortuberculosis infection. If there is a case of tuberculosis at any school, the Superintendentand the School Nurse, under the direction of the appropriate officials of the CountyHealth Department, shall determine appropriate interventions.

A child may be exempt from the tuberculosis examination if it is contrary to his/herbeliefs. The child's parent/guardian or custodian must provide the school with an affidavitstating that the required examination is contrary to the child's beliefs. If there is probablecause to believe that such a child has active Tuberculosis, he/she may be excluded fromschool until the Board is satisfied that he/she is not so afflicted. (Health and Safety Code121505)

Students known to have had a positive tuberculosis skin test shall be excluded fromschool until they provide evidence of a follow-up x-ray and appropriate medical care orare considered by qualified medical personnel not to be at risk for tuberculosis infection.

(cf. 5112.2 - Exclusions from Attendance)(cf. 5141.3 - Health Examinations)

All district staff shall receive information on how tuberculosis is spread and how it can beprevented and treated.

(cf. 4119.43 - Universal Precautions)(cf. 5141.22 - Infectious Diseases)(cf. 5141.23 - Infectious Disease Prevention)

Legal Reference:

EDUCATION CODE48211 Habits and disease

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49450 Rules to insure proper care and secrecy49451 Parent's refusal to consent

HEALTH AND SAFETY CODE120875 Providing information to school districts on AIDS, AIDS-related conditions andHepatitis B120880 Information to employees of school district120230 Exclusion of persons from school121475-121520 Tuberculosis tests for pupils


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PIEDMONT UNIFIED SCHOOL DISTRICTBoard Policy

Instruction BP 6153

SCHOOL-SPONSORED TRIPS

The Board of Education recognizes that school-sponsored trips are importantcomponents of a student's development. Besides supplementing and enrichingclassroom learning experiences, such trips encourage new interests amongstudents, make them more aware of community resources, and help them relatetheir school experiences to the outside world. The Board believes that carefulplanning can greatly enhance the value and safety of such trips.

(cf. 1321 - Solicitation of Funds from and by Students)(cf. 6145 - Extracurricular and Cocurricular Activities)

All trips involving overnight and/or out-of-state travel field trips shall require theprior approval of the Board. Other trips may be approved by the Superintendentor designee.

Principals shall ensure that teachers develop plans which provide for the safetyof students and their proper supervision by certificated staff on all school-sponsored trips.

The Board does not endorse, support, or assume liability in any way for any staffmember of this district who takes students on trips not approved by the Board orSuperintendent or designee. No staff member may solicit students of this districtfor such trips within the facilities or on the school grounds of the district withoutBoard permission.

Legal Reference:EDUCATION CODE8760 Authorization of outdoor science and conservation programs32040 Duty to equip school with first aid kit32041 Field trips32043 Snakebite kits on field trips32044 Violations35330 Excursions and field trips35331 Provision for medical or hospital service for pupils (on field trips)35332 Transportation by chartered airline35350 Transportation of students44808 Liability when pupils not on school property48908 Duties of pupils; authority of teachers

Adopted: January 10, 2001Revised: January 27, 2015

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Piedmont Unified SDAdministrative Regulation

AR 6153Instruction

School-Sponsored Trips

All planned trips away from school grounds, including athletic trips and outdooreducation programs, are subject to this regulation.

Students must have written parental permission in order to participate in tripsrequiring transportation. (Education Code 35350) The district shall provide analternative educational experience for students whose parents/guardians do notwish them to participate in a trip.

Safety and First Aid

1. While conducting a trip, the teacher, employee or agent of the school shallhave the school's first aid kit in his/her possession or immediately available.(Education Code 32040, 32041)

2. Whenever trips are conducted in areas known to be infested with poisonoussnakes:

a. The first aid kit taken on the trip shall contain medically accepted snakebiteremedies. (Education Code 32043)

b. The trip shall be accompanied by a teacher, employee or agent of the schoolwho has completed a first aid course which is certified by the American RedCross and which emphasizes the treatment of snakebites. (Education Code32043)

Supervision

1. Students on approved trips are under the jurisdiction of the Board ofEducation and subject to school rules and regulations.

2. Teachers or other certificated personnel shall accompany students on all tripsand shall assume responsibility for their proper conduct.

3. Before the trip, teachers shall provide any adult chaperones who mayaccompany the students with clear information regarding their responsibilities.

4. Lead trip staff shall develop a plan for identifying, securing and dispensing anymedications consistent with physicians' instructions and Board Policy andAdministrative Regulation 5141.21.

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4. 5. Teachers and chaperones shall not consume alcoholic beverages or usecontrolled substances while accompanying and supervising students on a trip.

Trip Approval

1. Teachers planning a trip shall make a request in writing to the principal.

2. The principal shall approve or disapprove the request and notify the teacher. Ifthe trip is disapproved, the principal should state the reasons.

3. Principals may exclude from the trip any student whose presence on the tripwould pose a safety or disciplinary risk.

4. Principals shall approve no activities which they consider to be inherentlydangerous to students or to pose unacceptable, unmitigated risks.

Regulation PIEDMONT UNIFIED SCHOOL DISTRICTPiedmont, California

Approved: January 10, 2001Revised: January 27, 2015

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Documents

Piedmont Unified School District · January 2015 Establish enrollment projection for initial revenue and expenditure estimates January 9, 2015 Governor releases proposal for the subsequent