F 04002 2026

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The document outlines the requirements for Wisconsin schools to report student immunization compliance to local health departments for the 2017-2018 school year. It specifies that all students through grade 12 must provide evidence of vaccinations or waivers, and schools must submit aggregate compliance data by the 40th school day. The document includes instructions for completing the report form, definitions of compliance categories, and details on how to categorize students based on their immunization status.

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Click ‘Get Form’ to open the F-04002 in the editor.
In Section A, enter the contact information for your school. This includes the DPI LEA (District) Code, DPI School Code, and the grades enrolled. Use our platform's search feature to find these codes easily.
Move to Section B and list the number of students in each category from rows 1 through 7. Ensure that each student is counted only once in a category. The total in row 8 must match your enrollment numbers.
In Section C, report the number of students who have received no immunizations and possess a waiver for all vaccines. Again, ensure accuracy by putting zeros where applicable.
Once completed, review all entries for accuracy before submitting. You can save or print directly from our platform for easy distribution.

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