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Tally Sheets

These tally sheets were designed to assist schools in gathering the information required for the "School Health Annual Request for Reimbursement" report. They should NOT be submitted to the Division of School Health. These forms have been updated for school year 2015-16.

Tally sheets are provided for the collection of daily and monthly data, in two formats:

     1. Electronic- Data may be entered directly onto the tally sheets via the computer. They have been designed in an Excel format and are "functional" meaning that they will automatically calculate the data as it is entered. Before entering data, save this file to your computer by using the "Save as" function (Click on File, then Save As). Only cells requiring data input are accessible. The other cells are locked.

     2. Manual- These tally sheets may be printed and used in hard-copy format.

Average Daily Membership (ADM) - Private and non-public schools receiving school health services from school districts are to report their ADM numbers, to the school district, at the end of each school year for submission in the annual school health report.

  1. Average Daily Membership (ADM) - Manual
  2. Average Daily Membership (ADM) - Electronic

Dental Program (Mandated and Dental Hygiene)

  1. Mandated Dental Program - Daily/Monthly - Electronic
  2. Mandated Dental Program - Daily/Monthly - Manual
  1. Dental Hygiene Services Program - Monthly - Electronic
  2. Dental Hygiene Services Program - Monthly - Manual
  1. Fluoride Program - Monthly - Electronic
  2. Fluoride Program - Monthly - Manual

Mandated Health Screens

  1. Health Screens - Daily - Electronic
  2. Health Screens - Daily - Manual
  3. Health Screens - Daily/Monthly - Electronic
  4. Health Screens - Daily/Monthly - Manual

Health Services

  1. Health Services - Daily/Monthly - Electronic
  2. Health Services - Daily/Monthly - Manual

Medication Administration

  1. Medication Administration - Daily - Electronic
  2. Medication Administration - Daily - Manual
  3. Medication Administration - Monthly - Electronic
  4. Medication Administration - Monthly - Manual

Physical Examinations

  1. Physical Examinations - Daily/Monthly - Electronic 
  2. Physical Examinations - Daily/Monthly - Manual

Serious School Injury

  1. Serious School Injury - Daily/Monthly - Electronic
  2. Serious School Injury - Daily/Monthly - Manual