School Coverage - Grantee Data, Contacts, Scope of Report

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School Vaccination Coverage
for Kindergarten and Middle School

Grantee Information, Points of Contact & Scope of Report

THIS PAGE IS PROVIDED FOR INFORMATION PURPOSES ONLY. YOU CANNOT USE THIS PAGE TO SUBMIT YOUR ANNUAL SCHOOL COVERAGE REPORT. THE SCHOOL VACCINATION COVERAGE REPORT IS HOSTED ON A SECURE SITE REQUIRING A DIGITAL CERTIFICATE. IF YOU NEED INFORMATION ON HOW TO ACCESS THE SITE AND/OR OBTAIN A DIGITAL CERTIFICATE PLEASE CONTACT Robert Avey

grantee report data

Grantee Project Area
School Year
Program Manager

Preparer information

Name: Title:

Phone: Ext: Email:

school point of contact

Primary Contact

Name: Title:

Phone: Ext: Email:
Fax:

Emails to the primary contact should cc: (Please provide another contact person)

Name
Phone Ext: Email
Fax

scope of the report

1. School Survey Methodology
Type of SchoolSchools Surveyed

3. Do you use survey results for a retrospective analysis? (Retrospective means using the data to look at coverage when the children were younger, i.e. 2 years old.)

No
Yes

4. How were the data for this report collected?

Health Department personnel reviewed each child's vaccination record
School nurse
Registry
School staff trained by the health department
School staff not trained by the health department
Other (specify):

4A. If the data were self-reports by schools, how were the results validated by the health department?

Validation not necessary because we used a scientific sample or complete census AND DOH or school nurses collected the data.
Validation was done using a scientific random sample and DOH/school nurses collected the data.
Other - explain in detail and contact CDC for consultation.
Explanation:

SDN imposes a 15 minute timeout. You must save data at least once every 15 minutes or entered/unsaved data will be lost

5. What is the source of the child's vaccination information in the school record? Check all that apply.

Provider (doctor, nurse, PA, clinic)
Registry
Shot card/parent-held record signed by a provider
Shot card/parent-held record NOT signed by a provider
Other, specify

6. What immunization information is included in the student's record?

Vaccine/antigen
Date received
Number of doses received
Other (describe):

7. Does the health department receive all of the above information for each child?

No
Yes

8. Do you have a grace period (i.e. 14 days) for students who are not up-to-date?

No
Yes (how long): # of days...999 = Unofficial/unlimited grace period

9. The vaccination data for this report represents vaccination rates:

On the first day of school
By December 31
Later in the school year-- When?

10. Do you collect vaccination dates?

Yes
No
It depends (explain)

11. What process is used to determine up-to-date status? (check one)

Count the vaccine doses received regardless of age and time interval
Count the vaccine doses received at the appropriate age.
Count the vaccine doses received at the appropriate age and time interval
Other (explain)

Please select "Final" when you have completed all data entry for the School Scope of Report/Demographics section.

In-processFinal

"Save Data/Continue" will save your data and move you to the Kindergarten section.

cdc contacts

Report/Content Issues:Contact CDC with questions or requests for assistance on school report content
Technical/Website Issues:Robert Avey

Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, U.S.A
Tel: (404) 639-3311 / Public Inquiries: (404) 639-3534 / (800) 311-3435

Department of Health
and Human Services

School Vaccination Coverage for Kindergarten and Middle School