School Assessment Reports

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 have not complied with the State health and immunization requirements upon school entry, and students who have religious or medical exemptions. The EPI 12A report should be 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)
EPI 12A EXCEL
EPI 12B EXCEL

Send electronic version via secure email to:  [email protected]

Printable Version of Immunization Assessment Report Forms (PDF)
EPI 12A PDF
EPI 12B PDF

Send printable form via Fax to:    (808) 586-7511

Or mail to:
State of Hawaii Department of Health
Immunization Branch
P.O. Box 3378
Honolulu, HI  96801

School List (School Year 2020-2021)
 

EPI 10 Forms

 

Immunization Exemptions – medical and religious exemption data submitted by each school for students in kindergarten through grade 12

 

Last reviewed October 2020