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School Report to Local Health Department (F-04002) - Formalu

School Report to Local Health Department (F-04002) - Formalu 2026

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The document outlines the requirements for Wisconsin schools to report student immunization compliance to local health departments for the 2021-2022 school year. It specifies that all students through grade 12 must provide evidence of vaccination status or a signed waiver. Schools are required to submit aggregate compliance data by the 40th school day, using a designated form (F-04002) that includes detailed sections for reporting enrollment and vaccination categories.

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Click ‘Get Form’ to open the School Report to Local Health Department (F-04002) in our editor.
In Section A, enter the school's contact information, including the DPI LEA and school codes. Use the provided links to search for these codes if needed.
Proceed to Sections B and C, where you will categorize students based on their vaccination status. Ensure that each category is filled accurately, entering '0' for any categories without students.
Review your entries for accuracy before submitting. Make sure all totals align with the enrollment figures provided in Section A.
Once completed, submit the form through the online REDCap survey link provided in the instructions.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (105 Votes)
2015	4.2 Satisfied (58 Votes)
2008	4.2 Satisfied (38 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the formula for number needed to vaccinate?

Traditional NNV calculations are often based on NNT estimates, and are written:(1.1)NNV = 1/(Ru Rv)where Rv is the risk among vaccinated individuals.

What is the formula for calculating vaccine wastage rate?

Vaccine wastage was calculated by the following formula: (vaccine doses supplied vaccine doses used)/vaccine doses supplied.

What is the formula for calculating vaccine requirements?

The equation you should use to estimate the annual vaccine needs by this method is given below: Annual vaccine needs = posts x weeks x sessions x vials x doses, where: posts = number of immunization sites. weeks = number of weeks the service is delivered during the year.

What is the formula for calculating vaccine coverage?

In most countries administrative coverage data are the number of doses administered to the target population. In order to estimate percentage immunization coverage, this number is divided by the total estimated number of people in the target population.

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