- Everett Public Schools
Health Services
Seizure Record
Effective: 7-01, 4/03, 5/04, 1/08
SEIZURE RECORD
STUDENT’S NAME DATE
CLASSROOM TIME OF OCCURRENCE
PRECEDING CONDITIONS:
Student’s Location Student’s Activity
Warning Signs No Yes If “Yes” describe
SEIZURE BEHAVIOR:
Duration (if approximate, state it)
Did student’s body stiffen? No Yes
Any apparent injury? Did student appear to become unaware of the environment? - - - - - - - - - -- - - - - - - - - - - - - - Urine No Yes
Feces No Yes
Did student have difficulty breathing?
Seizure Record 08.docx 
