Annual School Immunization Compliance Report to State

Inspection template for compiling and verifying the annual aggregate immunization compliance report for enrolled students before submission to the state or local health department.

Report Identification and Scope

• Reporting period matches the current annual filing cycle
  Verify the report covers the correct school year or reporting period required by the state or local health department.
• School or program name, site code, and district identifier are complete
  Confirm the report header identifies the correct campus, program, and administrative unit.
• Grade levels or age groups included are correctly defined
  Select all enrolled groups included in the annual report.
• State reporting form or portal version is current
  Verify the submission uses the current required form, portal, or data file format.
• Submission due date and planned filing date are documented
  Record the official due date and the intended submission date/time.

Enrollment and Denominator Verification

• Total enrolled student count is reconciled to the official enrollment roster
  Verify the denominator used in the report matches the official enrollment count for the reporting period.
• Students excluded from the report are documented by approved reason
  Document any exclusions from the denominator and ensure they are allowed by the reporting guidance.
• Late enrollees and withdrawals are handled consistently with state guidance
  Confirm students added or withdrawn near the count date are included or excluded according to the applicable rules.
• Duplicate student records were identified and resolved
  Check for duplicate records that could inflate counts or distort compliance percentages.

Immunization Status Data Review

• Up-to-date immunization count is verified against source records
  Confirm the number of students meeting all required immunization requirements for their grade or age group.
• Provisional attendance count is verified against source records
  Record students attending under provisional status, if allowed by state rules.
• Medical exemption count is verified against source records
  Count students with valid medical exemptions supported by documentation.
• Non-medical exemption count is verified against source records
  Count students with valid non-medical exemptions, if permitted by the state.
• Students missing required immunization records are identified
  Verify the count of students lacking required records or documentation. Any nonzero count requires follow-up.
• Compliance percentages are calculated correctly
  Check that all percentages, ratios, and totals are mathematically correct and align with the denominator.

Documentation and Evidence Review

• Source records are current and traceable to student files or immunization registry data
  Verify the report is supported by current school health records, provider documentation, or registry data.
• Record review includes documentation of missing or incomplete entries
  Confirm that incomplete records and follow-up actions are documented for internal tracking.
• Audit trail or reviewer notes are retained
  Ensure there is a retained review trail showing who compiled and verified the report.
• No personally identifiable information is included in the aggregate submission beyond what is required
  Confirm the submission contains only the minimum required information and does not expose unnecessary student PII.

Submission, Corrective Actions, and Sign-Off

• Deficiencies or non-conformances are documented with corrective actions
  List any discrepancies, missing records, or calculation issues and the corrective action plan.
• Report is ready for submission to the state or local health department
  Confirm the report is complete, reviewed, and ready to file.
• Submission method is documented
  Record how the report will be submitted.
• Inspector or reviewer signature
  Signature of the person verifying the annual immunization compliance report.