Annual School/Facility Immunization Survey

The Role of the School Nurse

Brittany Taylor, MPH

Immunization Program

Agenda

Who is being surveyed

The role of the School Nurse

How to complete the survey on paper

How to complete the survey online

Who to contact with questions

Timeline and Deadlines

Helpful hints

Who is being surveyed?

All schools and childcare centers in Kentucky must report for the children in the following grades or groups:

Sixth grade

Kindergarten

Head start

Preschool

Daycare

Role of the School Nurse Receive the survey, worksheets and

instructions from the local health department

Access immunization certificates/information for children in the appropriate grade/group

Complete the worksheet using the instructions provided

Complete the survey using the completed worksheet and instructions provided

Role of the School Nurse cont.

Review the survey to reduce errors before sending

Return the survey to local health department via mail, fax, or online submission by the deadline

Make corrections to the survey if it is necessary and resubmit

Immunization Certificate

Provisional Certificate

Medical Exemption

Religious Exemption

Reading the Certificate

Completing the Worksheet

2009 Annual Immunization Survey

Completing the top portionList current and former namesMust list County

Must circle Private or Public

Please include valid number

Indicate ONLY 1.Each grade/group must complete a separate form

A

B

C

E

D

***** Please only use valid numbers: B + C + D + E = A *****

Current, Provisional, & Expired Certificates

Completing the bottom portion

•Indicate the number of children who have had the age appropriate vaccines listed to the left.

•Write NA if the vaccine is not applicable. (ie: Td booster is not appropriate for childcare and Kindergarten.)

•‘Combination’ does not refer to a single shot, but rather a series of immunizations over the course of time.

•Do not leave any of the 9 cells blank.

Online Survey on KIP website

http://chfs.ky.gov/dph/epi/Immunization+Program.htm

2009 Annual Immunization Survey

•Type 1 response in each text box.

•All questions on the survey with an asterisk will require a response

Must click Private OR Public

Indicate date that survey is prepared

•Indicate ONLY 1 grade/group

•Each grade/group must complete a separate survey

# of Children in grade/group with NO Immunization Certificate on file

#

#

#

#

#

Click here to submit the survey when complete

All cells here require an answer.

Indicate the number of children who have had the age appropriate vaccines listed to the left.

Write NA if the vaccine is not applicable. (ie: Td booster is not appropriate for childcare and Kindergarten.)

Completing the Survey• Completing the Survey is required by KY state

regulation 902 KAR 2:055 and CDC.

• All blank fields require an answer/response

• A separate survey is required for each childcare, kindergarten, and/or 6th grade at each school/facility

• Childcares only assess children ages

19 mo -5yrs.

• Children in before/after school programs are assessed only in their school (excluding the childcare)

Who to Contact

For questions regarding the school survey that are not addressed in the

instructions, please contact the School Survey contact person at your local

health department.

Note: some counties have a different people for schools and daycares

Helpful Hints• Utilize the Worksheets and Instructions

that are sent with the survey

• Check over the final form to ensure that it is filled out correctly before returning to the local health department.

• Never leave any response areas blank

• Remember that the purpose of the survey is to assess number of children with age appropriate doses

QUESTIONS?

Thank you!

Brittany Taylor, MPH

Brittany.Taylor@ky.gov

502-564-4478 ext. 4038

Re: Kindergarten and

Sixth Grade

Carrie Tuggle

Carrie.Tuggle@ky.gov

502-564-4478 ext. 3690

Re: Childcare Centers (Daycare, Preschool, Headstart)