The NJ Annual Immunization Report Form is a crucial document designed by the New Jersey Department of Health. It serves to ensure compliance with the state's immunization requirements. Schools and child care facilities are required to submit this form annually, reporting the immunization status of their enrollees across various age and grade levels.
The New Jersey Annual Immunization Status Report Form is a comprehensive document introduced by the New Jersey Department of Health to ensure that all schools and childcare facilities maintain up-to-date records of student vaccinations, as per state immunization requirements. This crucial form gathers detailed information about the immunization status of students across various educational levels—from childcare facilities to elementary and secondary schools. It obligates reporting on the total enrollment and vaccination compliance, including provisional admittance and exemptions based on medical or religious grounds. Additionally, it covers special considerations for transfer students and those in ungraded special education. The form also extends to evaluating the influenza vaccine's effectiveness among preschool-aged children through a voluntary survey. By submitting this report, schools affirm their commitment to public health and compliance with New Jersey's stringent immunization mandates, playing a pivotal role in safeguarding community well-being against preventable diseases.
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An n u a l I m m u n iz a t ion St a t u s Re por t
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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
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?
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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
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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]
The New Jersey Annual Immunization Status Report is a necessity for schools and child care facilities to ensure all enrolled pupils comply with the state's immunization requirements. It requires accurate reporting of pupils' immunization status across different grades and categories. This detailed process involves collecting and reporting data on those meeting requirements, provisional admissions, and those with medical or religious exemptions. The subsequent steps are designed to assist you in accurately completing the form.
By conscientiously filling out the New Jersey Annual Immunization Status Report, your facility contributes vital information that aids in maintaining public health standards for children. This process ensures the safety and well-being of all pupils by upholding state immunization requirements.
The NJ Annual Immunization Report is a required form that schools and child care facilities in New Jersey must submit to the Department of Health. It details the immunization status of enrolled students, ensuring compliance with the state's immunization requirements.
Any school or child care facility within New Jersey, regardless of being public or non-public, must complete this report. It covers all enrolled pupils in entry-level grades, grade 6, transfer students from out-of-state or out of the country, and, for child care facilities, all children over 2 months of age in pre-K.
The form requires detailed information about the facility, including:
Provisional admittance is granted to pupils who have begun or are in the process of completing all required immunizations. These pupils should be accounted for separately in the report, indicating their progress towards meeting New Jersey's immunization mandates.
Yes, exemptions include medical or religious grounds. the report includes sections where schools can denote the number of pupils with such exemptions. It's crucial that these are documented accurately for compliance and record-keeping purposes.
Transfer students, those who are newly transferred into grades K-12 from any out-of-state or out-of-country school since the submission of the last year's status report, have a separate designation on the form. This helps track the immunization compliance of students who may not have been previously accounted for in the New Jersey system.
No, participation in the IVIS is voluntary. However, this survey assists in assessing the effectiveness of the influenza vaccination programs for preschool-aged children. Schools with students under 60 months of age are encouraged to participate.
After filling out the necessary information, facilities can submit the form electronically through the provided link on the New Jersey Department of Health's website. It’s recommended to print out a submission confirmation for record-keeping.
For assistance, schools and facilities can contact the New Jersey Department of Health directly. The department offers guidance and support for completing and submitting the Annual Immunization Status Report, ensuring all requirements are met efficiently.
When filling out the New Jersey Annual Immunization Status Report form, several common mistakes can impact the submission's accuracy and compliance. Awareness of these errors is crucial for schools and child care facilities to ensure they accurately report their immunization status. Here are six common mistakes:
To ensure the accuracy and completeness of the Annual Immunization Status Report, it is beneficial for individuals responsible for its preparation to carefully review all entries and adhere strictly to the New Jersey Department of Health's guidelines.
Filling out the New Jersey Annual Immunization Status Report form is a crucial step for schools and child care facilities to comply with state health regulations. However, this form is usually not the only document required. Below is a list of other forms and documents often used alongside it to ensure comprehensive health and safety compliance within educational and child care environments.
Together with the New Jersey Annual Immunization Status Report, these documents form a robust framework for ensuring the well-being and safety of children in educational and care settings. By meticulously completing and updating these records, schools and child care facilities play a vital role in upholding public health standards and safeguarding the community against vaccine-preventable diseases.
The Vaccine Administration Record (VAR) is one document that shares similarities with the NJ Annual Immunization Report form. Both documents are used to track and report vaccinations. While the NJ form focuses on the immunization status of students within educational institutions, the VAR typically documents individual vaccine administration events, tracking the vaccine type, dose, and date given to a person. Both forms play critical roles in maintaining public health records and ensuring compliance with vaccination requirements.
Another related document is the Medical Exemption Form for Vaccinations. This form, like a section of the NJ Annual Immunization Report, is used when individuals are exempt from getting certain vaccines due to medical reasons. Both documents require detailed information to confirm the validity of the exemption and to maintain accurate public health records, ensuring that all exemptions are properly accounted for within compliance efforts.
The Religious Exemption Form for Immunizations is akin to parts of the NJ Annual Immunization Report that record religious exemptions. This form allows individuals to claim an exemption from vaccinations based on religious beliefs. Both the NJ report and the religious exemption form underscore the importance of documenting exemptions to vaccination mandates, ensuring that schools and child care facilities adhere to legal requirements while respecting individual beliefs.
The School Vaccination Requirements Checklist, much like the NJ report, serves schools and child care facilities. It outlines the specific vaccines children must receive at certain age levels or grades. This checklist is a tool for educational institutions to ensure that they are in compliance with state immunization laws, paralleling the NJ form's function of collecting and reporting the immunization status of students to health authorities.
The Child Care Immunization Record is another document with a similar purpose to the NJ Annual Immunization Report. Focused on younger children in pre-kindergarten and child care settings, this form tracks the immunization status of enrolled children, ensuring that they meet state-mandated vaccine requirements. Both documents are necessary for evaluating compliance with vaccine laws in environments where young children are cared for outside their homes.
The Immunization Survey Form is utilized to gather data on vaccination rates within a particular community or institution, similar to the optional influenza vaccine implementation survey mentioned in the NJ form. Both surveys aim to assess the coverage and effectiveness of vaccination programs, helping public health officials to identify areas with low immunization rates and to develop strategies to increase vaccine uptake.
The Student Health Record, which encompasses a student's comprehensive health history, including immunizations, is another document with similarities to the NJ Annual Immunization Report. While the health record provides a detailed view of a student's health over time, including allergies, medications, and physical exam results, the section regarding immunizations aligns closely with the purpose of the NJ report, ensuring that the student meets school entry requirements.
The Influenza Vaccine Documentation Form, specifically related to the influenza vaccine data collection in the NJ report, is used to track flu vaccine administration in various settings. This form, like the NJ report's optional influenza survey, helps health departments and educational institutions measure compliance with flu vaccine recommendations and mandates, particularly for children in daycare and preschool settings.
Lastly, the Vaccine Inventory Log shares a logistical similarity with the NJ Annual Immunization Report. While the inventory log is primarily used by healthcare providers to manage and record vaccine supplies, it indirectly supports the accuracy of immunization reporting by ensuring that adequate vaccine stock is available for administration. Proper inventory management contributes to the overall effectiveness of public health vaccination initiatives, aligning with the goals of the NJ immunization report.
When completing the New Jersey Annual Immunization Status Report form, there are essential steps to follow to ensure accuracy and compliance with state requirements. Please consider the following dos and don'ts:
There are several misconceptions about the New Jersey Annual Immunization Status Report form that need clarification. These misunderstandings can lead to confusion about the reporting requirements and the nature of the information that needs to be submitted.
Understanding these aspects of the New Jersey Annual Immunization Status Report form helps clarify its purpose and importance in promoting public health within the educational system. By dispelling these misconceptions, schools and child care facilities can more effectively contribute to state-wide immunization efforts.
When tackling the NJ Annual Immunization Report form, awareness and precision are vital. Begin by understanding the specific requirements laid out in the form. This includes the accurate documentation of immunization statuses for various groups such as entry-level grades, grade 6 pupils, transfer students, and, in specific cases, pre-K and childcare facility attendees. The primary goal is to ensure compliance with New Jersey’s immunization mandates, highlighting the importance of public health and safety within educational environments. Below are key takeaways for efficiently completing and utilizing this essential document:
Overall, the NJ Annual Immunization Report form serves as a critical tool in maintaining public health standards within educational settings. By ensuring thorough and accurate completion, schools and childcare facilities play a pivotal role in safeguarding community health, particularly among younger populations. Compliance with these requirements not only fulfills a legal obligation but also contributes significantly to the statewide effort to prevent vaccine-preventable diseases.
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