School & Child Care Immunization Assessment Reporting Forms

In the fall, annually, licensed child care facilities and schools with kindergartens will receive forms to report the immunization compliance of their students. 

The California Health and Safety Code section 120375 and the California Code of Regulations section 6075 require all childcare facilities to fill out the Annual Immunization Report On Children Enrolled In Child Care Centers (CDPH 8018) and schools with kindergartens to fill out the Immunization Assessment Of Kindergarten Students – Annual Report School Summary Sheet (PM 236).

Child care facilities will submit their reports to their local health department by October 15.

Kindergarten schools will submit their reports directly to the Immunization Branch at the address listed on the bottom of the PM 236 form by October 15.

Materials for Immunization Assessment of Child Care Centers

Materials for Immunization Assessment of Kindergarten Students

• Immunization Assessment of Kindergarten Students – Annual Report, School Summary Sheet, PM236
• Kindergarten Immunization Assessment Work Sheet
• Guide to the Immunizations Required for School Entry, Grades K-12, IMM 231
• The blue California School Immunization Record (CSIR) card (PM 286B)
  This is the record schools, child care centers and family child care providers must keep on file for every child enrolled. Blue CSIR cards are available free of charge from local health departments.

Materials for Immunization Assessment of 7th Grade Students

• Immunization Assessment of 7^th Grade Students  -- Annual Report
• Guide to Immunizations Required for School Entry
• Tdap Requirement Sticker (PM 286S) affixed to the blue California School Immunization Record (CSIR), both available free of charge at your local health department

For questions or concerns, please contact your local health department, or the Immunization Branch at (510) 620-3737.

Thank you for keeping California’s children protected from vaccine preventable diseases!