Exemption Review


Step 1- Gather a list of students who are exempt from one or more vaccines

Students who are exempt from one or more vaccines must have a current Certificate of Exemption on file.

There are several ways to gather a list of students depending on how a school stores immunization information.

For schools that are using paper, staff will need to manually go through and determine those exempt. According to Washington state law, a school must keep a current list of exempted students.

Sometimes it is helpful to put them in categories by grade or school.

Determine from which vaccines a student has an exemption- this step is especially critical for case management and notification during a potential vaccine-preventable disease outbreak (i.e measles or chickenpox).

For schools that use a computer system, there should be a report that can be printed to show students who are exempt for one or more vaccines.

It is still important for you to verify the accuracy of this information, as computers are not perfect.
Step 2- Develop a tracking system

Once you know who to contact, it is important to track progress and attempts at contacting parents. Find Sample Tracking Sheet here.

Developing a system to keep track of who and when in terms of contacting parents is critical to the follow-up process.


Some school nurses use their Outlook calendars to remind them who they need to follow-up with that day.

For districts that have computerized records, there may be a place to put notes on a student’s record.

In Skyward, some schools use the “office visit section” to make notes and run reports.
Step 3- Cross-reference the Washington State Immunization Information System (IIS) or (WAIIS)

If a school has access to the Washington State Immunization Information System (IIS), staff can cross-reference a child’s school exemption with immunization data in the IIS (formerly known as Child Profile).

Step 4- Start calling parents

The purpose of these calls is to see if the information a school has on file is correct.

Having an exemption for one or more vaccines is within the law to attend school; however, many times students eventually receive vaccines after an exemption was signed.

Sample phone scripts to call parents can be found here.
Step 5-Determine end date

Give ample time to the follow-up process. Although it may be tedious, it is the backbone to ensuring success of this process. Allow 3-4 weeks to follow-up with parents by phone to inquire about the accuracy of exemptions on files.

Please note that a school cannot exclude students who have a current and correctly-signed Certificate of Exemption. These students are permitted to attend school with this signed document.

Immunization Exemptions

A parent or guardian may choose to exempt their child from one or more of the immunization requirements for school. However, the child may be at risk for disease.

Children with exemptions have contributed to disease outbreaks of vaccine-preventable diseases throughout the state of Washington as well as the nation. These outbreaks put children, their family members, and community members (sometimes too young or unable to be vaccinated) at risk.

The Washington State Administrative Code 246-110 allows a health officer to exclude children from school or childcare during an outbreak of vaccine-preventable disease if the child has not been fully immunized due to a medical, religious, philosophical, or personal exemption.

Immunization Exemption Law

On May 10, 2011, Governor Gregoire signed a bill that requires a licensed health care provider to sign the Certificate of Exemption, for a parent or guardian to exempt their child from school and child care immunization requirements.

The signature verifies that the provider gave the parent or guardian information about the benefits and risks of immunization.

A health care provider doesn’t need to sign the form for parents or guardians who demonstrate membership in a church or religious group that does not allow a health care provider to provide medical treatment to a child. (please note: this is different than a religious exemption)

Determine exempt students.
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Develop a tracking system for your follow up.
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Cross-reference student record with IIS.
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Call and confirm
with parents if exemption is accurate.
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Determine end point of record review and document all data.
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