Vaccination Tracking and Reporting Tools

These resources enable nursing home staff to track and trend COVID-19 vaccine administration data, including boosters, for both residents and staff. The tools support efficient collection of information on vaccination rates and support the coordination of next doses and identification of vaccine hesitancy. Additionally, these resources can aid in data compilation and accuracy in reporting to CDC's National Healthcare Safety Network.

• COVID-19 Vaccination Tracking Tool for Use in Nursing Homes (ZIP, 538 KB)
  This pre-programmed Excel workbook compiles resident and staff COVID-19 vaccination information, including additional primary doses and boosters, to allow staff to regularly identify trends, rates and coverage gaps in the nursing home's COVID-19 vaccination program. Persons with disabilities experiencing problems accessing the content in the Excel file should contact Karen Fleming-Michael (301–427–1798, karen.flemingmichael@ahrq.hhs.gov) and ask for assistance. A team member will provide written or verbal guidance on the purpose of each tab in the tracker and how to use the tracker.
  User Guide: COVID-19 Vaccination Tracking Tool for Use in Skilled Nursing Facilities (PDF, 1.3 MB)
  This guide provides detailed, step-by-step instructions and visuals to record, analyze and review resident and staff COVID-19 vaccination data using the COVID-19 Vaccination Tracking Tool.
• Resident COVID-19 Vaccine Administration Record (Word, 92 KB)
  This one-page record-keeping tool allows nursing home staff to collect information on every resident who is offered the COVID-19 vaccine, including the vaccine manufacturer, additional primary dose and booster shots, dates each shot is administered, adverse reactions, and whether the resident declined the vaccine. The Word file also allows facilities to insert their logo on the form.
  Instructions for Resident COVID-19 Vaccine Administration Record (PDF, 307 KB)
  These instructions guide nursing home staff on how to enter the information requested in the Resident Vaccine Administration Record for COVID-19.
• Staff COVID-19 Vaccine Administration Record (Word, 92 KB)
  This one-page recordkeeping tool allows nursing home administration to collect information on every staff member who is offered the COVID-19 vaccine, including the vaccine manufacturer, additional primary dose and booster shots, dates each shot is administered, adverse reactions, and whether the staff member declined the vaccine. The Word file also allows facilities to insert their logo on the form.
  Instructions for Staff COVID-19 Vaccine Administration Record (PDF, 328 KB)
  These instructions guide nursing home staff on how to enter the information requested in the Staff COVID-19 Vaccine Administration Record.