Welcome to
the 2019-2020 NC Health Assessment Report
Please
take the time to review this landing page. Then, print and read all of the
linked worksheets and instructions; also use them for references as you are
completing the online report. There are blank worksheets and worksheet
instructions for the Health Assessment and the Immunization Report.
Once you have prepared your responses and are ready to begin that process,
scroll to the bottom of this page and click on the NEXT button
to begin the online report.
Note that after entering school and contact information, private schools will
be automatically directed to the Immunization portion of the report they are
required to submit. Other schools will complete the Health Assessment and then
be redirected to the Immunization Report.
Health
Assessment Report Instructions
(Private schools are NOT subject to the Health Assessment Report
requirements)
Students enrolling in an NC school for the first time are required to present a Health Assessment Transmittal Form within 30 calendar days
of school admission, pursuant to NC G.S. 130A-441. Reports are due no later
than November 1, 2019;
however, they may be completed at any time following the 30th calendar day from
the first day of the new school year. If completing a report for more than one
school (with different school IDs), please complete a separate report for each
school. After submitting the first report, a link will be provided to complete
the report for another school.
Private schools should begin this report by entering contact
information and school information. After indicating the school type is a
private school, you will have the option to complete the Health Assessment for
your own records if you choose to do so. However, private schools are not
required to complete the Health Assessment. If you do not choose to complete
the Health Assessment, you will be redirected to the Immunization Report for
Kindergarten and 7th grade.
Please click here to download a copy of the blank
Health Assessment Report worksheet that you may use to prepare your responses.
This worksheet should be used as a tool to gather the necessary information
before entering it into the online report. Note: Reporting the total enrollment
for new students (reported on the Health Assessment) is different from the
total enrollment (reported on the Immunization Report).
When the worksheet has been completed and checked for accuracy, please click
the "Next" button at the bottom of this page to begin the online
report, using data collected on the worksheet. Do NOT submit OR mail
the worksheet itself.
If you have trouble submitting either report or need technical assistance
please contact Colleen Ehatt, Children & Youth Branch Data Manager, at colleen.ehatt@dhhs.nc.gov.
Thank you.
Please note that after clicking "Next" you will have
the option to save and continue the survey at a later time. On
the top of the screen, you will see a green "Save and
continue" bar; once you click this link you will be prompted to
enter your email address. You will receive an edit link to this email address
to use to continue and submit the survey at a later time.
Contact Information
Name of
representative completing this report*
_________________________________________________
Title of representative
completing this report*
_________________________________________________
Email of
representative completing this report*
_________________________________________________
School Information
School Type*
( ) Public (including Innovative Schools)
( ) Private
( ) Charter/Lab
( ) Special School (Federal, DHHS, DPS, Tribal, etc.)
County*
6-Digit
School Number
Note: If the school number is not known, please ask the school
administrator or the data manager. Public and federal schools have two
three-digit LEA numbers combined into one six-digit school number.
Charter schools have a two-digit numerical number followed by one letter,
followed by three zeros. Lab schools have a two-digit numerical number followed
by Z, followed by three zeros.
You can also look up your school number by clicking here. *
_________________________________________________
School
District*
School Information
School
Name*
_________________________________________
School Address*
_________________________________________________
School City*
_________________________________________________
School Zip Code*
_________________________________________________
School Phone Number
(including area code but no dashes)*
_________________________________________________
Principal's Name*
_________________________________________________
Principal's
Email*
_________________________________________________
Contact email for
questions*
_________________________________________________
Contact phone
number for questions (including area code but no dashes)*
_________________________________________________
Does anyone
other than the school Principal or the survey respondent need to receive a copy
of this report once it is submitted? If so, please enter that person's email
address.
_________________________________________________
Please
select the grade(s) that your school serves.
Note: This report should only reflect the school whose name was entered
above, i.e., only one report on one school at a time. If you need to report on
additional schools, you will be redirected to do so at the end of this report.*
1. What is
your school's official start date? If your school serves multiple grades with
different start dates, please select the latest start date. *
_________________________________________________
Only public schools,
public special schools, and public charter schools are required to report on
Health Assessment Transmittal Forms. Although you are not required to complete
the NC Health Assessment, you do have the option to complete it. Would you like
to proceed to the Health Assessment Report? If not, you will be redirected to
the Immunization Report.*
( ) Yes, I would like to complete the Health Assessment
Report
( ) No, I would like to be redirected to the Immunization
Report.
Health Assessment
Note:
The Health Assessment questions reflect students enrolled for the first time in
an NC public school. The Immunization Report questions reflect the total number
of students enrolled in your school for either kindergarten or 7th grade as
applicable.
Please
note, the numbering on the Health Assessment Items below have been formatted to
match the numbers on the blank word document template.
2. Health
Assessment Summary (Kindergarten)*
________2a. Total number of kindergarten students enrolled
for the first time in a North Carolina Public School. *Note this is NOT the
same as total students enrolled. DO NOT count those who are repeating
kindergarten in the Health Assessment questions.
________2b. Total number of Health Assessment Transmittal
forms on file for first time kindergarten enrollees within 30 days of beginning
school.
________2c. Total number of first-time kindergarten
students who have religious exemptions for health assessments in place within
30 calendar days of beginning school.
________D. Total number of kindergarten students not in
compliance: A-(B+C)
3. Health
Assessment Summary (1st-12th grade)*
________3e. Total number of 1st-12th grade students
enrolled for the first time in an NC public school. *Note this is NOT the
same as total students enrolled. DO NOT count those who are repeating a grade
for the Health Assessment questions.
________3f. Total number of Health Assessment Transmittal
Forms on file for first time enrollees within 30 calendar days of beginning
school.
________3g. Total number of students who have religious
exemptions for health assessments in place within 30 calendar days of beginning
school.
________H. Total number of 1st-12th grade students not in compliance:
E-(F+G)
2d. Total
number of first time Kindergarten students not in compliance:
This is calculated by the following formula: Question 2a - (2b+2c)=2d
_________________________________________________
3h. Total
number of first time 1st through 12th grade students not in compliance:
This is calculated by the following formula: Question 3e - (3f+3g)=3h
_________________________________________________