Immunization Checklist

Form Template

School immunization programs are critical to public health.

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Schools have vaccination requirements to protect the health and safety of all students. Before making an appointment at an immunization clinic or health care facility, a family may want to determine which vaccination is required to attend school. The Immunization Checklist app is a guide to determine if a student has had the required immunizations to attend school. While the checklist is a tool for reviewing vaccinations, official immunization records are required for each student. The checklist includes the doses and the appropriate age to vaccinate the child. Required immunizations include Tetanus, Varicella Vaccine, Measles, Mumps and Rubella (MMR), Tetanus, and Hepatitis B vaccination. Families should also sign the Statement of Chicken Pox if the student does not require the Varicella Vaccine. The app includes Information to obtain waivers if electing not to vaccinate the student. This app is a useful tool for families and schools to communicate about required immunizations.

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