ATTACHMENT A - CERTIFICATION OF IMMUNIZATION.docx

Attachment A

CERTIFICATION OF IMMUNIZATION

The Indian Health Service (IHS) Employee Immunization Policy requires all IHS employees (includes temporary employees, volunteer workers, contractors and consultants) working in an IHS hospital or clinic are required to be immune to Rubeola (measles) and Rubella (German measles). Immunity to Rubeola and Rubella is a condition of employment, with exceptions only for demonstrated allergy to the vaccine.

Other immunizations are recommended but not required:

1. Individuals with patient contact should be immunized yearly against influenza.

2. Individuals with frequent contact with blood or blood products should be immune to Hepatitis B.

3. All individuals should be immune to Diphtheria, Tetanus, and Mumps.

4. All individuals at special risk should be immunized against other specific infections such as Pneumococcal disease, Polio or Rabies.

Standards for being considered immune to Rubeola and Rubella are described below. The following documentation is required:

· Rubeola (Measles) - Provide date of birth: _

Individuals born prior to 1957 need not be considered susceptible; measles vaccine or proof of immunity is not required.

Individuals born in 1957 or after will be considered immune only if they provide documentation of physician-diagnosed measles, laboratory evidence of measles immunity or adequate immunization with two doses of live measles vaccine on or after their first birthday.

· Rubella (German measles) - Individuals shall provide documentation of immunity to Rubella by record of laboratory evidence of immunity or documented immunization with live virus vaccine on or after the first birthday.

Signature Date

Name: Printed or Typed