School Immunization Record Management Toolkit

1.Train school and childcare support staff.

Staff training is important to ensure all immunization information is collected and maintained in the same way.

Staff should be trained on the number of doses required of each type of vaccine for childcare/pre-school/school entry. Intervals can be complicated, but it will save follow-up hours with parents later if staff know immunization intervals and invalid doses information. Immunization schedules and easy to read vaccine requirement charts from the Washington State Department of Health can help aid in training.

The Certificate of Immunization Status (CIS) overlay can help with training. This document can be printed on a transparency sheet and then laid over a CIS to ensure dates are provided in the highlighted areas – the transparency file can be found here. Entry requirements can be found here.

2. Educate parents who are already in your district.

Kindergarten entry – A district may have groups that will automatically be entering into kindergarten such as Head Start/Early Childhood Education and Assistance Program (ECEAP) or pre-school groups. Talking with these parents prior to school helps ensure you are collecting and maintaining immunizations consistently. Cover the topics below with these parents through an in-person meeting.

• Kindergarten immunizations required for school entry
• Explain the Certificate of Immunization Status (CIS) form and that it requires a parent signature

Before 6th grade – Before school is out every year, send letters home to current parents of 5th grade students letting them know about the Tdap vaccination required for 6th grade school entry. Most staff utilize this mailing to inform parents of the meningococcal and human papillomavirus (HPV) vaccine recommendations, as required by law. Example letters can be found here.

It is also beneficial for staff/volunteers to attend 6th grade orientation and remind parents about the requirement.

Some school districts find it helpful to not assign the student a class schedule until the immunization record is updated.

All grades – Before school is out every year, send letters home to parents that include a back-to-school list that includes immunization information, including required immunizations for school entry.

Have registration packets available for parents prior to school registration. This will help some parents fill out the CIS in advance of attending a registration event—saving you (and the parent) time.

3. Verify immunization at registration event and cross-reference the Washington State Immunization Information System (WAIIS).

Whether you have a registration event or not, the best time to ensure immunizations are current and accurate is while you have the parent in front of you. Although it may seem time consuming, it is an important step to ensuring childcare attendees and students have the appropriate immunizations prior to starting. As indicated in step 1, having staff trained to interpret if the child or student has the needed immunizations is critical. Refer to step 1 for training resources.

During any kind of registration event, make a computer and printing station available and print completed CIS forms out of the Washington Immunization Information System (WAIIS) for parents to sign and turn in with registration documents. This will allow the parent to add any immunization that may not be on the CIS from the WAIIS and can minimize mistakes when copying dates onto the CIS.

Another practice found to be beneficial for school districts during the registration process is to hold immunization clinics to enable same-day student vaccinations. School districts that have done this successfully worked with partners in the community such as local health departments and/or their Medical Reserve Corps to offer free or low-cost immunizations. See the Imms-To-Go toolkit for more information.

4. Create student profile in Student Information System (SIS).

In many school districts there is a time delay between when the student registers and when they are entered into the Student Information System (SIS).

In order to run reports to find students who registered and are not compliant, the initial data entry is required. The sooner this data is entered the more time school staff have to get students up-to-date before school starts.

5. Call parents of students with missing immunization information.

Before school starts, school staff should generate an out-of-compliance report or refer to their tracking sheet, and start calling parents to get updated immunization information—some school districts allow school nurses or secretarial staff to start half-days before school begins. These staff can then take a full day off during the year by combining it with a naturally-occurring school half day. Other possibilities are to recruit other staff to help, such as detention staff, parent advocates and health clerks, who may not be as busy before school starts.

Keep trying parents. Many times parents are just busy and need reminders.

Find sample phone call scripts here. As records are provided to the school from parents, ensure these updates are added to the SIS.

1.Identify out-of-compliance students.

“Out-of-compliance” can be defined as those children who do not meet the requirements for attending school due to inadequate immunization records. This group of children does NOT include those with exemptions on file or those children that are conditional (cannot obtain immunizations at this time due to minimum age or intervals of vaccine schedule). You can find the current requirements to attend school by checking here.

2. Develop a tracking system.

Once school staff know who to contact, it is important to track progress and attempts at contacting parents. Find sample tracking sheet here.

Developing a system to keep track of who and when a parent is contacted is critical to the follow-up process.

TIP: Some school nurses use their Outlook calendars to remind themselves who they need to follow-up with that day.

For districts that have computerized records, the system may allow you to put notes on a student’s record.

3. Cross-reference the Washington State Immunization Information System (WAIIS).

If a school has access to the Washington State Immunization Information System (WAIIS), staff can cross-reference a child’s school immunization record with immunization data in this database (FYI– The WAIIS was also formerly referred to as Child Profile).

4. Send letters or emails to parents of out-of-compliance students.

Below is a list of current letters that can be modified to meet your needs, including organization or district logo and contact information. You can find any of these sample letters in Microsoft Word Format in the

“School Sample Letter” section here.

• Graduating Senior Letter
• HPV Letter for Private Schools
• HPV Letter for Public Schools
• HPV and Meningococcal Letter (combination)
• Meningococcal Letter
• Notice of Child’s Conditional Immunization Status (Public and Private Schools)
• Notice of Exclusion for Immunization Noncompliance (Private Schools)
• Notice of Exclusion for Immunization Noncompliance (Public Schools)
• Tdap Letter for 6th grade
• Tdap for 7th grade
• Tdap/Varicella Letter (combination)
• Varicella Requirement Letter for 9th-12th grade

Once the letter is developed, a separate letter for each student will need to be printed out and

1. mailed
2. emailed or
3. sent home with students.

If funds are available, it may help to include a self-addressed stamped envelope for parents to return updated information, as well as updated contact information.

Mailing and calling parents are the most effective methods of contacting parents.

TIP: If a school has parent names and addresses in an exportable form, or if a school has them typed into Excel, they may find Microsoft Word’s mail merge tool useful. The functionality allows staff to create letters and envelopes that are pre-populated with names and address. Click here for more information about Microsoft Mail Merge.

5. Start calling parents.

Start calling parents right away. Even though staff know the parents have not received a letter yet, staff can let them know the letter is on its way.

Staff have only 30 days to get the needed immunization information before the child is excluded from school, so it is important to start the follow-up as soon as a student is identified as out-of-compliance.

Keep trying parents. Many times parents are just busy and need reminders.

Sample phone scripts to call parents can be found in here.

As records are provided to the school from the parents, ensure these updates are added to the current system of immunization record keeping.

6. Mail or hand-deliver exclusion letters.

Within 30 days, complete the phone follow-up and update tracking sheet. According to the WAC, schools are obligated to exclude these children until a completed Certificate of Immunization Status (CIS) or a completed Certificate of Exemption (COE) is provided. Parents are notified that their child will be excluded by mailing an Exclusion Letter, which must be sent by Certified Mail, or hand-delivering an Exclusion Letter. The child is excluded upon receipt of the letter, until the child is compliant. Many school districts will utilize resource officers to hand-deliver letters, or even distribute them during parent-teacher conferences.

If a parent requests a Certificate of Exemption, there are two ways this form can be completed:

1. Most will need a healthcare provider signature on the form before it can be accepted by the school.
2. There is an option on the form to claim a religious exemption for affiliation with a religious entity that does not believe in medical care. If this section of the Certificate of Exemption is filled out, the parent can sign the form.

1.Gather a list of students who are exempt from one or more vaccines.

Students who are exempt from one or more vaccines must have a current Certificate of Exemption on file.

There are several ways to gather a list of students depending on how a school stores immunization information.

For schools that are using paper, staff will need to manually go through and determine those exempt. According to Washington state law, a school must keep a current list of exempted students.

Sometimes it is helpful to put them in categories by grade or school.

Determine from which vaccines a student has an exemption- this step is especially critical for case management and notification during a potential vaccine-preventable disease outbreak (i.e measles or chickenpox).

For schools that use a computer system, there should be a report that can be printed to show students who are exempt for one or more vaccines.

It is still important for you to verify the accuracy of this information, as computers are not perfect.

2. Develop a tracking system.

Once you know who to contact, it is important to track progress and attempts at contacting parents. Find Sample Tracking Sheet here.

Developing a system to keep track of who and when in terms of contacting parents is critical to the follow-up process.

TIPS: Some school nurses use their Outlook calendars to remind them who they need to follow-up with that day.

For districts that have computerized records, there may be a place to put notes on a student’s record.

In Skyward, some schools use the “office visit section” to make notes and run reports.

3. Cross-reference the Washington State Immunization Information System (WAIIS).

If a school has access to the Washington State Immunization Information System (WAIIS), staff can cross-reference a child’s school exemption with immunization data in the WAIIS (formerly known as Child Profile).

4. Start calling parents.

The purpose of these calls is to see if the information a school has on file is correct.

Having an exemption for one or more vaccines is within the law to attend school; however, many times students eventually receive vaccines after an exemption was signed. Sample phone scripts to call parents can be found here.

5. Determine end date.

Give ample time to the follow-up process. Although it may be tedious, it is the backbone to ensuring success of this process. Allow 3-4 weeks to follow-up with parents by phone to inquire about the accuracy of exemptions on files.

Please note that a school cannot exclude students who have a current and correctly-signed Certificate of Exemption. These students are permitted to attend school with this signed document except as directed by the local health officer during an outbreak.