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In the realm of public health, ensuring that all pupils attending school or child care facilities are adequately immunized against various diseases is paramount. The New Jersey Department of Health's Annual Immunization Status Report serves as a crucial tool in this endeavor, providing a structured mechanism for schools and child care facilities throughout New Jersey to report the immunization statuses of their students. It requires basic identification information such as the School ID, County, and the Name of the School/Child Care Facility, alongside specifics on enrollment numbers and the immunization status - including exemptions - of students across different grades. Particularly, this reporting covers students in entry-level grades, grade 6, and transfer students from out-of-state or country, reflecting a comprehensive approach to monitoring public health safety. Additionally, the form offers an avenue for these institutions to participate in the Influenza Vaccine Implementation Survey, aiming to assess the effectiveness of influenza vaccination programs among preschool-aged children. The importance of this form cannot be overstated, as it not only ensures compliance with New Jersey Immunization requirements but also plays a vital role in preventing the spread of vaccine-preventable diseases within the community.

Sample - Nj Annual Immunization Report Form

New jersey Department of Health

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Se a r ch

This Sit e

D OH H om e

An n u a l I m m u n iz a t ion St a t u s Re por t

* Required Fields

*Sch ool I D :

*Cou n t y :

School Dist rict :

* Nam e of School/ Child Care Facilit y:

I f Facilit y Recent ly Changed Nam e, List Previous Nam e:

M a ilin g Addr e ss:

*St reet :

*Cit y:

Sch ool Addr e ss ( if dif f e r e n t f r om a bov e )

St reet :

Cit y:

-

 

Mu n cipalit y

Select a County

Code:

 

* Zip Code:

Zip Code:

( not required)

*Nam e of Person Com plet ing t he Form :

School Em ail Address:

Nam e of Principal/ Person in Charge:

* Tot al School/ Child Care Cent er Enrollm ent :

*Elem ent ary/ Secondary School/ Child Care Facilit y:

* Telephone:

Tit le:

Public Non - Public

The school is responsible for assuring t hat all pupils are in com pliance w it h t he New Jersey

I m m unizat ion requirem ent s. I n t he boxes below , ent er t he st at us of all pupils in your ent ry level grade, grade 6, and t ransfer st udent s ( any grade) .

Child care facilit ies m ust ent er t he im m unizat ion st at us of all enrolled children w ho are over 2 m ont hs of age on t he pre - k line

I f your school has pre - kindergart en classes , ent er t hose children on t he pre - k line.

I f your school has a kindergart en grade , ent er t hose children on t he kindergart en line.

Do not include dat a in t he grade 1 boxes unless t he st udent is beginning school for t he very first t im e in grade 1 .

All pupils ent ering grade 6 record on t he grade 6 line.

Ungraded special educat ion pupils should be included w it h t he appropriat e age cohort class.

N ot

* N u m be r of

Pu pils M e e t in g All

+ Pu pils w it h Pu pils w it h Pu pils w it h Pu pils w it h

Gr a de Le v e lPu pils

Applica ble En r olle d

Im m u n iz a t ion Re qu ir e m e n t s

Pr ov ision a l

M e dica l

Re ligiou s

St a t u s

Adm it t a n ce

Ex e m pt ion s

Ex e m pt ion s

U n k n ow n

Pr e - k :

Kin der gar t en :

Grade 1:

Grade 6:

** Transfer St udent s

( Out of

St at e/ Count ry only) :

+ Provisional Adm it t ance - t hose pupils w ho have begun or are in t he process of com plet ing all t he required im m unizat ions.

* * Transfer St udent s - all st udent s new ly t ransferred int o grades K- 12 from any out - of - st at e/ out - of count ry school since subm ission of last year's st at us report .

* Opt ional

I f you do n ot have any st udent s under 60 m ont hs of age, t hank you for com plet ing your Annual I m m unizat ion St at us Report . Please click on subm it and print out your subm ission .

I f you have st udent s under 60 m ont hs of age, please consider assist ing us in assessing t he efficacy of t he influenza vaccine requirem ent . To part icipat e in I nfluenza Vaccine I m plem ent at ion Survey ( I VI S) , please click 'Yes' below . To not part icipat e, please click on 'No' .

Are you w illing t o com plet e t he I VI S?

Yes

No

I n f lu e n z a V a ccin e I m ple m e n t a t ion Su r v e y ( I V I S)

As per N. J. A. C. 8: 57 - 4 . 19, children six m ont hs t hrough 59 m ont hs of age at t ending any licensed child care cent er, or preschool facilit y shall annually receive at least one dose of influenza vaccine bet w een Sept em ber 1 and Decem ber 31 of each year .

Alt hough t he survey is volunt ary, w e need t o evaluat e t he com pliance w it h and t he effect iveness of t he influenza vaccinat ion program s for preschool aged children . We appreciat e your cooperat ion in filling out t his survey .

Tot a l # of St u de n t s

 

 

 

 

 

 

 

 

 

be t w e e n a ge s 6 - 5 9

Tot a l # of St u de n t s w h o r e ce iv e d

Tot a l # of Re ligiou s

Tot a l # of M e dica l

m os. su bj e ct t o t h e

in f lu e n z a v a ccin e by D e ce m be r

Ex e m pt ion s f or in f lu e n z a

Ex e m pt ion s gr a n t e d f or

 

in f lu e n z a

 

3 1 st

 

v a ccin e

in f lu e n z a v a ccin e

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D e pa r t m e n t of H e a lt h

P.O. Box 360, Trent on, NJ 08625 - 0360

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Last Modified: Monday, 29 - Dec- 14 11: 47: 23

http://highpoint.state.nj.us/health/cd/imm7/annualstatusrpt_form_current.shtml[12/29/2014 11:48:27 AM]

Document Specifications

Fact Number Description
1 The report is issued by the New Jersey Department of Health.
2 Completion of the Annual Immunization Status Report is required for schools and child care facilities.
3 Information regarding the facility's name, address, and person completing the form is mandatory.
4 The form includes sections for entry-level grade, grade 6, and transfer students' immunization statuses.
5 Facilities must report on immunization, provisional admittance, medical exemptions, religious exemptions, and unknown statuses for each required grade level.
6 Participation in the Influenza Vaccine Implementation Survey (IVIS) is optional for facilities with students under 60 months of age.
7 The legislation governing this reporting requirement is N.J.A.C. 8:57-4.19, which mandates influenza vaccination for children in licensed care and preschool facilities.
8 Schools and child care facilities must ensure compliance with New Jersey immunization requirements.
9 The form allows for reporting on students newly transferred from out-of-state or out-of-country schools.

Detailed Steps for Using Nj Annual Immunization Report

Filling out the New Jersey Annual Immunization Report form is a straightforward process that plays a crucial role in ensuring the health and safety of children in schools and child care facilities by tracking their immunization status according to New Jersey's requirements. By accurately completing this form, schools and child care facilities can help public health officials monitor immunization levels and prevent outbreaks of vaccine-preventable diseases. Let's walk through the steps needed to complete this important document.

  1. Enter the School ID as provided by the New Jersey Department of Health.
  2. Select your facility's County from the drop-down menu.
  3. Fill in the School District if applicable.
  4. Provide the Name of School/Child Care Facility. If the facility has changed its name recently, list the previous name in the designated space.
  5. Input the Mailing Address, including Street and City. If the school address differs from the mailing address, fill in the School Address section accordingly.
  6. Select the appropriate County Code for your facility.
  7. Enter the Zip Code for the school or facility. The second zip code field is not required if it's the same as the mailing address.
  8. Provide the Name of the Person Completing the Form and their Title.
  9. Enter the School Email Address and the Name of Principal/Person in Charge.
  10. Specify the Total School/Child Care Center Enrollment.
  11. Indicate whether the facility is a Public or Non-Public entity.
  12. For each required level (Pre-k, Kindergarten, Grade 1, Grade 6, and Transfer Students), enter the number of pupils in the following categories:
    • Enrolled
    • Meeting All Applicable Immunization Requirements
    • With Provisional Admission
    • With Medical Exemptions
    • With Religious Exemptions
    • Status Unknown
  13. If your school does not cater to students under 60 months of age, skip the next section. Otherwise, indicate whether you are willing to complete the Influenza Vaccine Implementation Survey (IVIS) by clicking 'Yes' or 'No'.
  14. If participating in the IVF, provide the total number of students between 6 - 59 months subject to the influenza vaccine, the number who received the influenza vaccine by December 31st, and the total number of religious and medical exemptions granted for the influenza vaccine.
  15. Once all information is accurately filled in, review the form to ensure completeness and accuracy.
  16. Submit the form by clicking the submit button at the bottom of the page and print out your submission for your records.

Completing the New Jersey Annual Immunization Report is a vital step in safeguarding the health of children in educational and care settings. By diligently reporting immunization statuses, facilities not only comply with state requirements but also contribute to the broader public health mission of preventing vaccine-preventable diseases. Thank you for your attention to this important process.

Learn More on Nj Annual Immunization Report

What is the New Jersey Annual Immunization Status Report?

The New Jersey Annual Immunization Status Report is a form that schools and child care facilities in New Jersey must fill out and submit to the New Jersey Department of Health. This document is used to report the immunization status of students and children in these institutions, ensuring compliance with New Jersey's immunization requirements.

Who needs to fill out this report?

All public and non-public schools as well as child care facilities in New Jersey are required to complete the Annual Immunization Status Report. This includes any facility with children over 2 months of age attending pre-kindergarten, kindergarten, entry-level grades, grade 6, and any new transfers from out-of-state or out-of-country schools.

What information is required on the form?

Information required on the form includes:

  • School or facility identification details such as name, mailing address, and contact information.
  • Total enrollment numbers.
  • A breakdown of the immunization status of pupils in specific entry-level grades, grade 6, and transfer students, including those meeting all immunization requirements, those with provisional admittance, medical exemptions, religious exemptions, and any unknown statuses.

What are provisional admittances?

Provisional admittance refers to pupils who have begun or are in the process of completing all required immunizations but have not yet met the full requirements. These students are allowed to attend school while they continue with their immunization schedules.

Are there exemptions to the immunization requirements?

Yes, exemptions are available for medical or religious reasons. Medical exemptions require documentation from a healthcare provider, while religious exemptions are granted based on the assertion of a sincere religious belief that prohibits immunizations.

How does the report address transfer students?

The report specifically requires information on students who have transferred into the state from out-of-state or out-of-country institutions since the submission of the last year's status report. Their immunization status must be monitored closely to ensure compliance with New Jersey’s immunization mandates.

What is the Influenza Vaccine Implementation Survey (IVIS)?

The IVIS is part of the report focusing on evaluating the compliance and effectiveness of influenza vaccination programs for preschool-aged children in licensed child care and preschool facilities. Participation in the survey is voluntary but highly encouraged to help assess the impact of influenza vaccine requirements among children six months through 59 months of age.

How are schools and facilities supposed to submit this report?

The exact submission process can vary, but typically schools and facilities submit the completed form electronically through the provided website link or mail it to the New Jersey Department of Health. It's advisable to check the current guidelines from the NJ Department of Health for the most accurate and up-to-date submission procedures.

Is participation in the Influenza Vaccine Implementation Survey mandatory?

No, participation in the Influenza Vaccine Implementation Survey (IVIS) is voluntary. However, the New Jersey Department of Health encourages all schools and child care facilities with students under 60 months of age to participate. This data helps in assessing the efficacy of the state's influenza vaccine requirements.

Where can I find more information about immunization requirements in New Jersey?

For more information about immunization requirements in New Jersey, schools and child care facilities can visit the New Jersey Department of Health's website or contact their offices directly. The website offers detailed guidelines, resources, and contacts that can assist in understanding and complying with the state's immunization laws and policies.

Common mistakes

Completing the New Jersey Annual Immunization Status Report form meticulously is critical for school administrators and child care facility managers, ensuring all students' immunization records are accurately reflected and compliant with state regulations. Nonetheless, several common errors can undermine the integrity of this reporting process:

  1. Skipping required fields: The form identifies certain information as mandatory, delineated by asterisks (*). These fields often include school identification details, contact information of the person filling out the form, and specific enrollment and immunization data for various grade levels. Omitting information in these required fields can result in incomplete submissions, potentially affecting the accuracy of statewide immunization status assessments.

  2. Inaccurate reporting of immunization exemptions: There are provisions for provisional admission, medical, and religious exemptions that should be carefully reported. Misclassification among these categories or inaccurate counts of exempted pupils will distort the actual immunization landscape of the school or child care facility, which could mislead health department efforts to ensure high vaccination coverage and protect community health.

  3. Misunderstanding the scope of the reporting requirement: Some administrators may not realize that the report requires details not only on regular students within predefined grade levels (entry level, grade 6, etc.) but also on transfer students from out-of-state or out-of-country schools. Additionally, there is a need to report on specific age groups for child care facilities, particularly concerning the influenza vaccine requirement. Overlooking these nuanced requirements can lead to underreporting or incomplete compliance assessment.

  4. Failure to update contact information: The form requests the name and title of the person completing the form, along with the school’s email address. Not keeping this information current can result in communication gaps between the Department of Health and the educational institution, especially if clarification or additional information is needed post-submission.

Addressing these common mistakes requires a meticulous review process, awareness of the requirements, and clear communication among school or facility staff involved in health record management. Comprehensive training and reference resources can also support accurate and efficient completion of the New Jersey Annual Immunization Status Report form.

Documents used along the form

The New Jersey Annual Immunization Status Report is an essential tool for tracking compliance with the state's immunization requirements across schools and childcare facilities. It ensures that all New Jersey students meet necessary vaccination standards, safeguarding public health within educational environments. To complete this report comprehensively, several other documents and forms are often utilized to gather and verify the required information. These additional documents not only facilitate accurate reporting but also support the overall objective of maintaining a healthy, safe educational setting for all students.

  • Student Enrollment Form: This document records the details of each student's enrollment in the school or childcare facility, providing a baseline for determining who needs to be included in the immunization review.
  • Immunization Record Form: Maintained for each student, this form tracks all vaccinations received, including dates, types of vaccines, and healthcare provider information.
  • Medical Exemption Form: For students who cannot receive certain immunizations due to medical reasons, this document, completed by a healthcare provider, provides evidence of the exemption.
  • Religious Exemption Statement: Some families may object to immunizations on religious grounds. This statement is a written declaration from the parent or guardian outlining those beliefs.
  • Provisional Admission Form: This allows students to begin attending school while in the process of receiving required immunizations, indicating a specific timeline for completion.
  • Transfer Student Immunization Verification Form: Used for students transferring from out of state or country, this verifies their immunization status against New Jersey's requirements.
  • Influenza Vaccine Documentation: Specifically for preschool-aged children and those in childcare, this record tracks annual influenza vaccination compliance, as mandated.
  • Vaccine Inventory Log: Schools and facilities administering vaccines onsite maintain this log to track vaccine types, quantities, and expiration dates, ensuring an adequate supply for compliance.
  • Outbreak Response Plan: In the event of a disease outbreak, this document outlines the steps to be taken, including notification of health authorities and emergency vaccination protocols.

Together, these documents play a crucial role in achieving the objectives set forth by the New Jersey Department of Health's immunization requirements. They facilitate the accurate monitoring and reporting of vaccination coverage, exemptions, and compliance within schools and childcare facilities. Ensuring that all children are adequately vaccinated is vital for their health and that of their communities, contributing to the prevention of vaccine-preventable diseases.

Similar forms

The New Jersey Department of Health's Vaccine Preventable Disease Program's Annual Child Care/Preschool Immunization Survey is a document that bears similarities with the NJ Annual Immunization Report form. Like the NJ Annual Immunization Report, this survey collects data on immunization coverage, exemptions, and compliance with vaccine requirements among children enrolled in child care or preschool settings. Both documents serve a public health function by monitoring and promoting vaccine uptake to prevent the spread of vaccine-preventable diseases in educational settings.

The School Entrance Health Form, used in various states, shares common aspects with the NJ Annual Immunization Report form. It requires information on a child’s vaccination status upon admission to a school, including verification of immunizations against specific diseases. This form, similar to the NJ Annual Immunization Report, ensures compliance with state immunization laws, aiming to maintain high vaccination rates and protect public health within school communities.

The College Immunization Record is another document that mirrors the NJ Annual Immunization Report form in its purpose and content. This form is typically required for college or university enrollment and includes sections for documenting immunizations against diseases like measles, mumps, and meningitis. Although targeting an older age group, it aligns with the NJ Annual Immunization Report in its goal of confirming immunity to prevent disease outbreaks in communal living and learning environments.

The Pediatric Immunization Record is a personal health document maintained by healthcare providers and parents, detailing a child’s vaccination history. While it serves more as a medical record than a report, it shares the characteristic of documenting vaccine compliance and exemptions with the NJ Annual Immunization Report form. Both documents contribute to the broader public health effort to monitor and increase vaccination rates among children.

The Influenza Vaccination Status Report for Healthcare Workers, required by some states and healthcare institutions, parallels the NJ Annual Immunization Report form in several respects. It tracks flu vaccination among healthcare staff, promoting workplace health and safety. Despite its different target population, this report emphasizes, akin to the NJ Annual Immunization Report form, the importance of immunization in preventing the spread of infectious diseases within a community, specifically among vulnerable populations.

Dos and Don'ts

Filling out the NJ Annual Immunization Report form is a vital task that ensures the health and safety of students in New Jersey. It requires attention to detail and an understanding of the immunization requirements. Below are several dos and don'ts that should be considered while completing this form:

  • Do ensure that all required fields marked with an asterisk (*) are filled out. These fields are mandatory and include essential information such as School ID, County, and the Name of the Person Completing the Form.
  • Do review the immunization status of all pupils accurately. It is crucial to report on the status of all pupils in your entry-level grade, grade 6, and transfer students from any out-of-state/out-of-country schools since the submission of the last year’s status report.
  • Do report provisional admittance accurately for those pupils who have begun or are in the process of completing all required immunizations.
  • Do make use of the section provided for children under pretense of a medical exemption or religious status, ensuring all exemptions are documented and correspond to New Jersey state laws.
  • Do participate in the Influenza Vaccine Implementation Survey (IVIS) if you have students under 60 months of age, as it assists in assessing the effectiveness of the influenza vaccination programs for preschool-aged children.
  • Don’t include data in grade boxes that do not apply to the instructions. For example, do not include data in the grade 1 boxes unless the student is beginning school for the very first time in grade 1.
  • Don’t guess or estimate numbers. Accuracy is crucial when reporting immunization statuses, exemptions, and the total school/childcare center enrollment.
  • Don’t overlook the optional sections if they are relevant to your school or facility. Even though some sections might be marked as optional, they provide valuable data for public health assessments.
  • Don’t rush through the form without double-checking all entries. An error might not only require you to resubmit but could also impact the accuracy of state health records.

Adhering to these guidelines when filling out the NJ Annual Immunization Report form helps ensure that the information provided is accurate and complete, contributing to the health and safety of students across New Jersey.

Misconceptions

When examining the NJ Annual Immunization Report Form, several misconceptions often arise, leading to confusion and potential non-compliance. Understanding these misconceptions is essential for accurate reporting and compliance with New Jersey Department of Health requirements. Here are four common misunderstandings clarified:

  • Only public schools need to submit the form: This is incorrect. Both public and non-public schools, including child care facilities, are required to complete and submit the NJ Annual Immunization Report Form. This requirement ensures that all children in educational settings are accounted for regarding immunization compliance, reflecting the form's sections that specifically ask for the type of institution reporting.
  • Transfer students are not required to be reported: In reality, the form requires information on transfer students from out of state or country, as indicated in the section titled "Transfer Students (Out of State/Country only)." This specific inclusion ensures that newly enrolled pupils' immunization statuses are tracked, adding to the overall understanding of compliance within the state.
  • The form only collects information on mandatory vaccinations: While the form primarily focuses on mandatory vaccinations, it also includes sections for reporting provisional admittance, medical exemptions, religious exemptions, and pupils with unknown status. This comprehensive approach allows schools and child care facilities to report various compliance statuses, showcasing the state's holistic view of immunization reporting.
  • Influenza vaccination tracking is optional: The form does indeed offer an Influenza Vaccine Implementation Survey (IVIS), which might seem optional. However, the phrasing "Are you willing to complete the IVIS?" coupled with a directive about influenza vaccine requirements for children in licensed child care centers or preschool facilities indicates an underlying expectation for facilities to track and report this information when applicable. Therefore, while participation in the survey component appears optional, the reporting of influenza vaccinations for eligible students can be seen as part of broader compliance efforts encouraged by the New Jersey Department of Health.

Understanding these points helps clarify responsibilities and expectations for schools and child care facilities in New Jersey, promoting better compliance and safeguarding public health through informed immunization reporting.

Key takeaways

Filling out and submitting the New Jersey Annual Immunization Status Report is a required task for all schools and child care facilities in New Jersey to ensure compliance with state immunization requirements. Here are key takeaways about properly completing and utilizing the NJ Annual Immunization Report form:

  • Accurate Reporting: It's imperative for the facility completing the form to accurately report the immunization status of pupils in their entry-level grade, grade 6, and transfer students from any out-of-state or out-of-country schools. Child care facilities must report on the immunization status of all enrolled children over 2 months of age.
  • Understanding Categories: The form categorizes pupils’ immunization statuses as meeting all applicable immunization requirements, provisional admittance, medical exemptions, religious exemptions, and unknown. Understanding and accurately categorizing each pupil’s status is critical for compliance and health safety within the institution.
  • Participation in the Influenza Vaccine Implementation Survey (IVIS): Participation in IVIS is optional but encouraged for facilities with students under 60 months of age. This survey assesses the compliance with and effectiveness of the influenza vaccination requirements and programs for preschool-aged children, providing valuable data for health authorities.
  • State Health Requirements: The Annual Immunization Status Report underscores the importance of adhering to New Jersey Administrative Code (N.J.A.C. 8:57-4.19), mandating that children six months through 59 months of age attending any licensed child care center or preschool facility receive at least one dose of the influenza vaccine between September 1 and December 31 of each year. Compliance with this requirement is crucial for public health within educational institutions.
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