Healthcare Worker Influenza Vaccination Report
This report is used to measure the influenza vaccination rates of healthcare workers in facilities throughout Rhode Island. Certain healthcare facilities are required to report vaccination information about their healthcare workers (both employees and non-employees). They are:
- Adult Day Care (ADC)
- Ambulatory Surgery Center (PHS)
- Freestanding Ambulatory Surgical Center (FAS)
- Freestanding Emergency Care Facility (FEC)
- Home Care Provider (HCP)
- Home Nursing Care Provider (HNC)
- Hospice (HSP)
- Hospital (HOS) (Each hospital should include workers at all premises)
- Kidney Disease Treatment (KDT)
- Nursing Facility (LTC)
- Nursing Service Agency (NPA)
- Organized Ambulatory Care Facility (ACF)
Facilities whose license number begins with the above abbreviations must report vaccination information. (Facility types not included in this list do not have to report.) A healthcare facility that has multiple sites, each with a different license number, should report separately.
Please complete this report each influenza season by May 15. If you have any questions, please contact Hanna Kim at 222-1961.
This report is divided into three sections:
I. Facility information
II. Employee healthcare workers
III. Non-employee healthcare workers
Please use the "Tab" or "Cursor" to move to the next field in the form.