School Vaccination Coverage
for Kindergarten and Middle School
Consolidated Summary for School Year 2010-11
This page is READ-ONLY. You cannot edit or save data entered on this page. You must use the individual survey pages.
Grantee Project Area:
School Year
Program Manager
1. School
Survey Methodology
Type of SchoolSchools
Surveyed
2A. If you utilized a survey to complete the school vaccination coverage assessment for 2009-10, was the survey strategy approved by CDC? Answered random sample or Not a random sample to either Q1 or Q2
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.)
4. How were the data for this report collected?
Describe training:
4A. If the data were self-reports by schools, how were the results validated by the health department?
Explanation:
4B. Were the results of your self-reported school survey consistent with the results of the validation (within the confidence interval of the sample)?To be answered if response to Q4A was option 2 or 3.
4C. Who will be sending the validation data (Excel file and variable description) to CDC's technical assistance link?Technical Assistance link
5. What is the source of the child's vaccination information in the school record? Check all that apply.
6. What immunization information is included in the student's record? Check all that apply
7. What immunization information does the health department receive? Check all that apply
8. Do you have a grace period (i.e. 14 days) for students who are not up-to-date?
# of days...999 = Unofficial/unlimited grace period
9. The vaccination data for this report represents vaccination rates:
-- When?
10. What process is used to determine up-to-date status? (check one)
Please fill in the blank with the appropriate numbers. (You
can get information on school enrollment from your department of education.)
11. What is the total number of schools in
that have kindergartens?
a. Public:
b. Private:
12. How many of the schools had data included in this report?
a. Public:
b. Private:
13. What is the total number of children enrolled in all
kindergartens in
?
a. Public:
b. Private:
14. How many kindergartners did you survey? (This should include children with a missing vaccination record.)
a. Public:
b. Private:
15. How many surveyed kindergarten children did not have a vaccination record?
a. Public:
b. Private:
15a. What happens to these children?
i. Public: (Check all that apply)
ii. Private: (Check all that apply)
Instructions for completing the exemption section:
Please report permanent exemptions and temporary exemptions separately. If you
are unable to do that, please use the spaces for permanent exemptions to report
total exemptions in each category. Make a note in the comment section
explaining how you reported the exemption data.
-
Comments and definitions on reporting vaccine requirements and doses:
-
Up-to-date(UTD) = received the appropriate doses of each vaccine.
-
Include a vaccine in your count whether it was administered individually or
through combination vaccines.
Please fill in the blank with the appropriate numbers. (You
can get information on school enrollment from your department of education.)
31. Please check each grade that you survey in Middle School:
a. Public:
b. Private:
32. What is the total number of schools in
that have any of the middle school grades listed in Q31?
a. Public:
b. Private:
33. How many of the schools in Q32 had data included in this report?
a. Public:
b. Private:
34. What is the total number of children in that are enrolled in any of the middle school grades listed in Q31?
a. Public:
6th Grade 7th Grade 8th Grade
b. Private:
6th Grade 7th Grade 8th Grade
35. How many middle school children did you survey? (This should include children with a missing vaccination record.)
a. Public:
6th Grade 7th Grade 8th Grade
b. Private:
6th Grade 7th Grade 8th Grade
36. How many surveyed middle school children did not have a vaccination record?
a. Public:
b. Private:
36a. What happens to these children?
i. Public: (Check all that apply)
ii. Private: (Check all that apply)
Instructions for completing the exemption section: Please
report permanent exemptions and temporary exemptions separately. If you are
unable to do that, please use the spaces for permanent exemptions to report
total exemptions in each category. Make a note in the comment section
explaining how you reported the exemption data.
-
Comments and definitions on reporting vaccine requirements and doses:
-
Up-to-date (UTD) = received the appropriate doses of each vaccine.
-
Include a vaccine in your count whether it was administered individually or
through combination vaccines.
49. Does your project have college vaccination mandates or
requirements for the following vaccines?
50. If you have college vaccine requirements that are not listed above or have additional comments about college vaccine requirements, please include them below
51. Are private schools obligated to conform to the vaccination laws and requirements?
52. If a home-schooled child participates in school sponsored activities (e.g., field trips, clubs, or sports), are they required to have vaccinations that match school requirements prior to participating?
53. Have there been any changes to the immunization requirements or laws for school or child care entry during the present school year?