Child Care – Out-of-compliance

Step 1-Find Children Who Are Out-of-Compliance

“Out-of-compliance” can be defined as those children who do not meet the requirements for attending child care due to inadequate immunization records. This group of children does NOT include those with exemptions on file or those children that are conditional (cannot obtain immunizations at this time due to minimum age or intervals of vaccine schedule). You can find the current requirements to attend child care by clicking here.
There are several ways to compile a child care list of out-of-compliance children, depending on how the child care stores immunization information. If the child care provider uses paper files, they will need to manually go through and determine which children’s files are not adequate. Make a list of these children. Use your child care tracking software to identify which children are out-of-compliance. There are different ways to group children: by age, by classroom, or it may be easier to alphabetize the entire center by name. Find the method of grouping children that works best for the child care center. As a child care provider identifies children out-of-compliance, they should list the specific needed immunizations, which will help later steps go faster.
Step 2-Determine the Best Way to Contact Parents

Two examples of ways to contact parents are listed below. Calling parents may not be the best option when they are working. Once the best contact method is determined, contact each parent.
  1. Give the CIS form, to parents in an email or as they sign-in their child, with highlights of what information they will need to provide.

  2. Sample Email/Note/Conversation:

    Hi (Parent Name),

    We are required by law to ensure we have accurate and up-to-date immunization information on file. We show your child is due for X, Y, Z. Please update the highlighted areas on the Certificate of Immunization Status form that is attached and return as soon as you are able.

Step 3-Determine Best Way to Track Progress

Once a child care provider knows who will be contacting the parent, it is important to track their progress and attempts. Example tracking sheet for children needing follow up can be found here. Example tracking sheet for children who are exempt can be found here.
Step 4-Gather Immunization Data from Parents

As parents provide completed records back to the child care, ensure updates are added to current immunization record-keeping system.
Step 5-Make a New List of Children Needing Follow-Up

Repeat steps 2-5 until data is accurate. Waiting too long for parents to get back to the child care provider can decrease the momentum of the child care provider’s immunization record review. After first contact with parents, it is recommended to remind them every few days to get the needed information. Keep trying. Although a child care provider may feel like a pest, many times parents are just busy and need reminders. Sample conversations with parents can be found here.
Step 6-Determine End of Follow-Up and Send Out Certified Exclusion Letters

Be sure to give ample time for the follow-up process. Although it is tedious, it is the backbone to ensuring success of a child care provider’s records review process. Allow three to four weeks to follow-up with parents after the initial contact. From the updated tracking sheet, a child care provider should be able to count the number of newly-compliant children. According to Washington Administrative Code (WAC), the child care center is obligated to exclude these children until a completed Certificate of Immunization Status (CIS) or Certificate of Exemption (COE) is provided to the child care.

Parents are notified that their child will be excluded by sending an Exclusion Letter, which must be sent by certified mail, or hand-delivering the exclusion letter to the parent or caregiver. Many child cares hand-deliver letters during child drop-off or pick-up, or parent-teacher events. The child is excluded upon receiving the certified letter until the child is compliant. Find a sample exclusion letter here.

Click here (mid-way down page) to get information about how to send certified mail. In addition to regular postage, there is an additional fee. Child care providers can pick up the form that must be attached to the letter at any post office. The form has a reference number that a provider can use to find out when their letter was delivered.

If a parent wishes to file a Certificate of Exemption, they will need to visit their health care provider, who will review their reasons for exemption and must sign the form. See the Immunization Requirements page to review the WAC and Revised Code of Washington (RCW).

Step 7-Send Yearly Immunization Status Report by November 1

State law requires child cares to report their center’s immunization status by November 1 of each year. Although a child care provider will not need to submit this report every time he/she performs an immunizations record review, it is important to have records up-to-date before submitting a yearly status report. There are two ways to submit a status report: 1) online or 2) through a faxable paper form. The Immunization Status Report form can be found by clicking here.
1. Find children who are out-of-compliance.
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2. Determine the best way to contact parents (via sign-in sheet, note, email).
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3. Determine best way to track when parent is contacted, as well as immunization status.
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4. Gather data from parents by a deadline.
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5. Make a new list of those children from original population that still need follow up.
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6. Mail out certified or hand-deliver exclusion letters.
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7. Send yearly immunization status report by November 1, as applicable.
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