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Healthcare Worker Influenza Vaccination Reporting


Hospitals, long-term care skilled nursing facilities, and free-standing ambulatory surgical centers are required to report influenza vaccinations, documented contraindications, and informed declination rates for staff in accordance with ORS 442.851 and OARS 333-018-0000 through 333-018-0145. All facilities were notified of this reporting requirement in September 2011.

Collecting Data

There are three documents to assist in collecting data:

  • Attachment A (pdf) represents the content of the annual healthcare worker influenza vaccination survey.
  • Attachment B (pdf) includes definitions for the data fields in the survey form (Attachment A).
  • Attachment C (pdf) is a sample Influenza Consent/Declination form that can be used to support the data to be collected for the survey. Note that influenza vaccination, medical contraindication, and refusal of vaccination must be documented. In addition, if your staff members are vaccinated outside of your facility, you need to document this fact so that these staff can be counted as vaccinated. The sample form in Attachment C provides a means to document this information.

Reporting Data


Starting with the 2014 – 2015 influenza season, Oregon will no longer collect Oregon-specific questions regarding vaccine delivery and promotion strategies.

Please input your facility’s rates before May 22, 2015 using the appropriate survey outlined below:

New for Hospitals (Acute Care Facilities)

New definition for counting healthcare personnel in an Acute Care Facility:

  • Acute care hospital inpatient and outpatient counts are to be combined and submitted on a single influenza vaccination summary data form. 
  • Inpatient and outpatient units/departments must share the same CMS Certification Number (CCN) as the hospital AND be physically attached to the acute care facility OR be co-located on the same medical campus and function as units of the acute care facility.
New for Inpatient Rehabilitation facilities (IRFs) and Ambulatory Surgery Centers (ASCs)

Starting with the 2014 – 2015 influenza season, in order to fulfill the U.S. Centers for Medicare and Medicaid Services (CMS) reporting requirement, IRFs and ASCs must enroll in the National Healthcare Safety Network (NHSN) and submit healthcare personnel influenza vaccination data using the NHSN Influenza Vaccination Module.

New for Long-term Care Facilities (LCTFs)

Long-term care facilities must complete the Healthcare Worker Influenza Vaccination Survey by either using the documents listed above or by completing this online survey.

Helpful NHSN training links:

Please contact Monika Samper or call 971-673-1111 with any questions.

Healthcare Worker Influenza Vaccination Report

Visit our Publications page to find current and previous reports based on this data.