School __________________________ Head Lice Infestation Log Year_________________

Student’s Name Findings Findings Findings Findings Findings

&Teacher
Date: Date: Date: Date: Date:
Findings: Live Lice Findings: Live Lice Findings: Live Lice Findings: Live Lice Findings: Live Lice
Nits Nits Nits Nits Nits
Clear Clear Clear Clear Clear
Last Tx Date: Last Tx Date: Last Tx Date: Last Tx Date: Last Tx Date:
Name of Tx: Name of Tx: Name of Tx: Name of Tx: Name of Tx:
Action: Admitted to school Action: Admitted to school Action: Admitted to school Action: Admitted to school Action: Admitted to school
Sent home for Tx Sent home for Tx Sent home for Tx Sent home for Tx Sent home for Tx
Other Other Other Other Other
Date: Date: Date: Date: Date:
Findings: Live Lice Findings: Live Lice Findings: Live Lice Findings: Live Lice Findings: Live Lice
Nits Nits Nits Nits Nits
Clear Clear Clear Clear Clear
Last Tx Date: Last Tx Date: Last Tx Date: Last Tx Date: Last Tx Date:
Name of Tx: Name of Tx: Name of Tx: Name of Tx: Name of Tx:
Action: Admitted to school Action: Admitted to school Action: Admitted to school Action: Admitted to school Action: Admitted to school
Sent home for Tx Sent home for Tx Sent home for Tx Sent home for Tx Sent home for Tx
Other Other Other Other Other
Date: Date: Date: Date: Date:
Findings: Live Lice Findings: Live Lice Findings: Live Lice Findings: Live Lice Findings: Live Lice
Nits Nits Nits Nits Nits
Clear Clear Clear Clear Clear
Last Tx Date: Last Tx Date: Last Tx Date: Last Tx Date: Last Tx Date:
Name of Tx: Name of Tx: Name of Tx: Name of Tx: Name of Tx:
Action: Admitted to school Action: Admitted to school Action: Admitted to school Action: Admitted to school Action: Admitted to school
Sent home for Tx Sent home for Tx Sent home for Tx Sent home for Tx Sent home for Tx
Other Other Other Other Other
Date: Date: Date: Date: Date:
Findings: Live Lice Findings: Live Lice Findings: Live Lice Findings: Live Lice Findings: Live Lice
Nits Nits Nits Nits Nits
Clear Clear Clear Clear Clear
Last Tx Date: Last Tx Date: Last Tx Date: Last Tx Date: Last Tx Date:
Name of Tx: Name of Tx: Name of Tx: Name of Tx: Name of Tx:
Action: Admitted to school Action: Admitted to school Action: Admitted to school Action: Admitted to school Action: Admitted to school
Sent home for Tx Sent home for Tx Sent home for Tx Sent home for Tx Sent home for Tx
Other Other Other Other Other
Date: Date: Date: Date: Date:
Findings: Live Lice Findings: Live Lice Findings: Live Lice Findings: Live Lice Findings: Live Lice
Nits Nits Nits Nits Nits
Clear Clear Clear Clear Clear
Last Tx Date: Last Tx Date: Last Tx Date: Last Tx Date: Last Tx Date:
Name of Tx: Name of Tx: Name of Tx: Name of Tx: Name of Tx:
Action: Admitted to school Action: Admitted to school Action: Admitted to school Action: Admitted to school Action: Admitted to school
Sent home for Tx Sent home for Tx Sent home for Tx Sent home for Tx Sent home for Tx
Other Other Other Other Other

Head lice infestation log 8/06

Head lice infestation log 8/06