Declaration of Immunization

Please note that immunization is not required, however, this declaration is mandatory for licensed childcare centres in B.C.

Immunization of Staff in Community Care Facilities

Employees, volunteers and others working in a community care facility

Applicants must complete and submit this form with their application.

This document may also be used at the time of initial employment to record compliance with the British Columbia immunization and TB control program by employees, volunteers and others working in the community care facility. Staff immunization is not mandatory in community care facilities however it is strongly recommended as a best practice to protect staff and persons in care. Licensees must keep a record of each employee’s immunization history even if the immunization is incomplete.

References:
Child Care Licensing Regulation Section 21
Residential Care Regulation Section 39(1) and Section 86

Question Title

* 1. Please enter your name, phone number and email

Name

Email Address

Phone Number

Question Title

* 2. Which centre are you applying for?

Question Title

* 3. I have read the recommended immunization schedule (see below) and to the best of my knowledge my immunization history is:

Yes

Unknown

I am aware that I may be asked to remain absent from the facility in the event of a disease outbreak.

Recommended Immunization Schedule

Recommended vaccines for health and childcare workers are identified in the Communicable Disease Control Immunization Program: Section III Immunization of Special Populations, available from the BC Centre for Disease Control website at

http://www.bccdc.ca/dis-cond/comm manual/CDManualChap2.htm

Recommended vaccines for health and childcare workers
All routine vaccines	Tetanus-diphtheria (Td), varicella, MMR Meningococcal C conjugate for those born on or after January 1, 1988
Polio Vaccine	Primary immunization is recommended for all health care workers (HCW). Administer a single booster dose 10 years after primary series Those who have not completed a full primary series should have the series completed, regardless of the interval since the last dose. Provided free.
Hepatitis B vaccine	Recommended and provided free by employers for: ∙HCWs who may be exposed to blood or body fluids, or who may be at increased risk of sharps injury, bites, or penetrating injuries. Not recommended for child care workers except in exceptional circumstances where direct contact with infected blood or body fluids is a likely and ongoing risk. BC Ministry of Health provides free vaccine to students of health care professions. Refer to BC Communicable Disease Control Manual, Chapter 2, Section VII Biological Products
Influenza vaccine	Immunize yearly. Provided free.

¹ For specific vaccine schedule information, refer to BC Communicable Disease Control Manual, Chapter 2, Section VII Biological Products .

Source: BC Centre for Disease Control. Communicable Disease Control Immunization Program. Section III – Immunization of Special Populations. July 2009. p. 46.