Schools are required to submit an Immunization Assessment Report (EPI 12A or EPI 12B) to the Hawaii Department of Health by October 10th and January 10th of every school year. Schools must identify students who are not in compliance with the State health and immunization requirements upon school entry and students who have religious or medical exemptions. The EPI 12A report is submitted by childcare centers, preschools, and head start programs and the EPI 12B report by schools with students in kindergarten through 12th grade.
School Immunization Assessment Report Forms (EPI 12 reports)
Instructions on Completing the Immunization Assessment Report
- EPI 12A – Childcare facilities (Instructions PDF)
- EPI 12B – Kindergarten through Grade 12 (Instructions PDF)
Electronic Version of Immunization Assessment Report Forms (EXCEL)
Printable Version of Immunization Assessment Report Forms (PDF)
School List with School ID (School Year 2020-2021)
Where to Submit Completed Forms:
1.Electronic submission is the preferred method. Send forms via secure email
2. If electronic means are not available, please Fax to: (808) 586-7511
3. If Fax is not available, mail to:
- State of Hawaii Department of Health
Immunization Branch
P.O. Box 3378
Honolulu, HI 96801