Healthcare Worker Influenza Vaccination Compliance Inspection

Tracks annual healthcare worker influenza vaccination status, declinations, and required documentation for compliance monitoring.

Inspection Scope and Roster

• Inspection period documented
  Record the vaccination compliance period being reviewed (for example, current influenza season).
• Healthcare worker roster matches inspection population
  Verify the roster includes all in-scope healthcare workers, including employees, licensed independent practitioners, students, agency staff, and volunteers as applicable.
• Roster source and date of extraction recorded
  Document the source system or roster file used and the date it was extracted.
• Applicable policy or SOP referenced
  Identify the facility policy governing influenza vaccination, declinations, and documentation retention.

Vaccination Status Verification

• Documented influenza vaccination on file for each in-scope worker
  Confirm each in-scope healthcare worker has documented receipt of the current seasonal influenza vaccine or an approved alternative status.
• Vaccination date recorded
  Record the date vaccination was administered for reviewed records.
• Vaccination documentation includes provider or source verification
  Verify documentation identifies the administering provider, clinic, pharmacy, or acceptable immunization record source.
• Vaccination documentation is legible and complete
  Confirm the record includes worker name, vaccine type or season, administration date, and supporting evidence sufficient for audit review.
• Accepted evidence type used
  Select the primary evidence type used to verify vaccination status.
• Records retained in accordance with retention requirements
  Verify vaccination records are retained in the designated system or file location and are retrievable for compliance review.

Declinations, Exemptions, and Education

• Signed declination form on file for unvaccinated workers
  Verify a signed declination is present for each worker who did not receive the influenza vaccine and is not otherwise documented as vaccinated.
• Medical contraindication or exemption documented when applicable
  Confirm any medical exemption or contraindication is supported by appropriate documentation and approved per policy.
• Declination reason recorded
  Select the documented reason for non-vaccination, if applicable.
• Required influenza education or counseling documented
  Verify education about influenza risks, vaccine benefits, and declination implications was documented for workers who declined vaccination.
• Follow-up plan documented for pending declinations or exemptions
  Confirm pending cases have a documented follow-up date, owner, or escalation path.

Compliance Monitoring and Reporting

• Compliance rate calculated for the inspection population
  Enter the percentage of in-scope healthcare workers with documented vaccination or approved exemption/declination.
• Non-compliant records identified and tracked
  Verify records missing vaccination, declination, or exemption documentation are listed for follow-up.
• Corrective actions assigned with due dates
  Confirm each deficiency has an assigned owner, corrective action, and due date.
• Leadership or infection prevention reporting completed
  Verify compliance results are reported to the appropriate leadership, employee health, or infection prevention stakeholders.

Inspector Attestation

• Inspector name
  Enter the name of the person completing the inspection.
• Inspector role
  Enter the inspector's role or department, such as employee health, infection prevention, or compliance.
• Inspection completed date and time
  Record when the compliance inspection was completed.
• Inspector signature
  Signature confirming the inspection findings are accurate and complete.