Out-of-Compliance Review

Step 1- Identify out-of-compliance students

Out-of-compliance can be defined as those students who do not meet the requirements to be attending school due to incomplete immunization records.

This group of students does NOT include those with documented proof of immunity, exemptions on file, or those students in conditional status (cannot obtain immunizations at this time due to minimum age or intervals of vaccine schedule or it has been less than 30 days after the first day of attendance).

To determine which students are out-of-compliance, school staff can refer to these requirements here.

There are a several ways to compile an out-of-compliance student list, depending on how a school stores immunization information.
  • For schools using paper, staff will need to manually go through and determine which students are not fully immunized.

    Make a separate list of these students. Sometimes it is helpful to put them in categories by grade or school. It is important to determine which vaccines they are missing.

    Spending time in this step will ease later steps. Find sample tracking sheet here.
  • For those that use computer systems, there should be an option to print out-of-compliance data. It is important to verify that these students are truly out of compliance, as computers are not perfect.
Step 2 -Develop a tracking system

Once school staff 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 a parent is contacted is critical to the follow-up process.

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

For districts that have computerized records, the system may allow you to put notes on a student’s record.
Step 3- Cross-Reference the Washington Immunization Information System

If a school has access to the Washington State Immunization Information System (IIS), staff can cross-reference a child’s school immunization record with immunization data in this database (FYI- The IIS was also formerly referred to as Child Profile).
Step 4- Send letters or emails to parents of out-of-compliance students

Below is a list of current letters that can be modified to meet your needs, including organization or district logo and contact information. You can find any of these sample letters in Microsoft Word Format in the “School Sample Letter” section here.

Graduating Senior Letter

HPV Letter for Private Schools

HPV Letter for Public Schools

HPV and Meningococcal Letter (combination)

Meningococcal Letter

Notice of Child’s Conditional Immunization Status (Public and Private Schools)

Notice of Exclusion for Immunization Noncompliance (Private Schools)

Notice of Exclusion for Immunization Noncompliance (Public Schools)

Tdap Letter for 6th grade

Tdap for 7th grade

Tdap/Varicella Letter (combination)

Varicella Requirement Letter for 9th-12th grade

Once the letter is developed, a separate letter for each student will need to be printed out and

(1) mailed
(2) emailed or
(3) sent home with students.

If funds are available, it may help to include a self-addressed stamped envelope for parents to return updated information, as well as updated contact information.

Mailing and calling parents are the most effective methods of contacting parents.

If a school has parent names and addresses in an exportable form, or if a school has them typed into Excel, they may find Microsoft Word’s mail merge tool useful. The functionality allows staff to create letters and envelopes that are pre-populated with names and address. Click here for more information about Microsoft Mail Merge.

Step 5- Start calling parents

Start calling parents right away. Even though staff know the parents have not received a letter yet, staff can let them know the letter is on its way.

Staff have only 30 days to get the needed immunization information before the child is excluded from school, so it is important to start the follow-up as soon as a student is identified as out-of-compliant.

Keep trying parents. Many times parents are just busy and need reminders.

Sample phone scripts to call parents can be found in here.

As records are provided to the school from the parents, ensure these updates are added to the current system of immunization record keeping.
Step 6- Mail or hand-deliver exclusion letters

Within 30 days, complete the phone follow-up and update tracking sheet. According to the WAC, schools are obligated to exclude these children until a completed Certificate of Immunization Status (CIS) or a completed Certificate of Exemption (COE) is provided. Parents are notified that their child will be excluded by mailing an Exclusion Letter, which must be sent by Certified Mail, or hand-delivering an Exclusion Letter. The child is excluded upon receipt of the letter, until the child is compliant. Find a sample exclusion letter here. Many school districts will utilize resource officers to hand-deliver letters, or even distribute them during parent-teacher conference events.

See the Immunization Requirements on this web site for school-related Washington Administrative Code (WAC) and Registered Code of Washington (RCW).

Click here (midway down page) for more information on how to send certified mail. There is an additional cost for this United States Postal Service (USPS) mail service. Certified mail forms can be obtained via online or at a physical post office location.

If a parent requests a Certificate of Exemption, there are two ways this form can be completed:

  1. Most will need a healthcare provider signature on the form before it can be accepted by the school.
  2. There is an option on the form to claim a religious exemption for affiliation with a religious entity that does not believe in medical care. If this section of the Certificate of Exemption is filled out, the parent can sign the form.



out-of-compliance students
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a tracking system
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the Washington State Immunization Information System (IIS) to find missing information
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letters or emails to parents of out-of-compliance students within 30 days
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parents (at the same time letters are sent)
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or hand-deliver exclusion letters after 30 days
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