Report Student Vaccination (ISPA)

What is the role of Toronto Public Health under the ISPA?

Toronto Public Health’s role under the ISPA is to maintain and review the vaccination records and/or exemptions for students attending grade school in Toronto. Under the ISPA, if a student does not have the required vaccinations or a valid exemption on file, a suspension order can be issued to the school principal by the Medical Officer of Health for the local public health unit.

What is the role of Schools under the ISPA?

Public and private grade schools in Ontario have responsibilities outlined in the ISPA. They are required to share specific student information to the local public health unit to support the administration of the ISPA as well as enforce a suspension order issued by the Medical Officer of Health.

Toronto Public Health works closely with grade schools and school boards to minimize disruptions and get as many students updated before the start of a suspension period in a school. The goal is to keep students in school while being up-to-date with the ISPA.

What is the role of Parent under the ISPA?

Parents and legal guardians’ role under the ISPA are to keep track of their child’s vaccinations and report them to their local public health unit. Parents can report their child’s vaccination record via Immunization Connect Ontario (ICON): toronto.ca/StudentVaccines. Vaccination is needed when:

• Beginning grade school
• Transferring to grade school in another area

Public health units keep vaccine records for the sole purpose of enacting ISPA and the Child Care and Early Years Act (CCEYA), Health care providers are not required to report vaccines to local public health units under the Acts.

If you got a letter from Toronto Public Health, it means that we do not have your child’s up-to-date vaccination record. If you already reported your child’s immunization(s) but still received a letter, additional information may be needed from you.

Vaccines should be up-to-date for the age of the child based on Ontario’s Immunization Schedule. For example, children between 14 -16 years of age need a tetanus, diphtheria and pertussis vaccine (Tdap) booster.

What You Need to Do:

1. Check Vaccination Records:
   1. Check your child’s yellow vaccine card to see whether they received the required vaccines (or age-appropriate boosters). If you are unsure, speak to a health care provider.
2. Getting missing vaccinations:
   1. If your child is missing one or more of the required vaccines (or age-appropriate boosters), make an appointment with a health care provider or make an appointment at a community clinic at TPHBookings.ca. to get vaccinated for free. Report the vaccination to Toronto Public Health. See options below.
   2. If your child already received the required vaccines (or age-appropriate boosters), report your child’s vaccination record to Toronto Public Health. See options below.
      1. If your child does not have a primary health care provider, please visit Health Care Connect to find a family doctor or nurse practitioner in Ontario.
3. Report Vaccination Record to TPH:
   1. Parents or students aged 16 and 17 are responsible for reporting child immunizations to Toronto Public Health. Health care providers do not have this responsibility.
4. Ways to report your child’s vaccination record to Toronto Public Health
   1. Submit online using ICON.
   2. Mail a copy to:
      Toronto Public Health
      Vaccine Preventable Diseases
      5100 Yonge Street, 2^nd Floor
      Toronto, ON, M2N 5V7
   3. Fax to 416-338-2487. On the fax cover sheet, make sure to include information that identifies the child (name, date of birth, OIID or health card number) and parent’s contact information.
   4. Email a copy to immunization@toronto.ca. Note that email is not a secure way to send health information but is an option.

You can also use these options to report vaccinations from outside Ontario/Canada or records in languages other than English.

5. Obtain a valid exemption:

Toronto Public Health strongly encourages all children attending school to get vaccinated. Maintaining high vaccination rates is essential to prevent vaccine-preventable diseases. Parents may have medical, religious, or philosophical reasons not to immunize their child. To ensure the exemption is valid a Medical Exemption form or a Statement of Conscience or Religious Belief form along with education session certificate must be provided to Toronto Public Health.  For more details see Vaccination Exemptions.

Why does Toronto Public Health send suspension orders to parents/students?

Under the Immunization of School Pupils Act (ISPA), students 17 years of age and younger must have a record of vaccination against nine diseases (based on their age) or a valid exemption, to attend school in Ontario. It is the responsibility of parents/guardians to ensure that these requirements are met. If a student receives a suspension order and the requirements of the ISPA have not been met, the student can be suspended from school for up to 20 school days.

What does a suspension order mean?

If a student receives a suspension order from Toronto Public Health, it means that Toronto Public Health has not received one of the following for the student:

• Document(s) showing the student has received vaccines for the following diseases: Diphtheria, Measles, Meningococcal disease, Mumps, Pertussis, Poliomyelitis, Rubella, Tetanus, Polio or, for students born in 2010 or later, Varicella. The vaccines should be up-to-date for the age of the student based on Ontario’s Immunization Schedule; or
• An unexpired Statement of Medical Exemption; or
• A Statement of Conscience or Religious Belief and confirmation that the parent completed the required education session. The Statement of Conscience or Religious Belief form must be sworn or affirmed by a Commissioner for Taking Affidavits.
  If the requirements of the ISPA are not met by the date stated in the suspension order, the student will be suspended from school.

Note: Reported vaccines should include the correct number of doses for the student’s age. For example, at 14 years of age most students need a tetanus, diphtheria and pertussis vaccine (Tdap) booster.

If vaccination records have been submitted and a suspension order is still received, please call 416-338-7600 and select option two for immunization where a customer service representative can provide more information.

What is included in a suspension order?

A suspension order will show:

• Name of student to be suspended;
• Dates for the suspension period (up to 20 school days);
• Immunization information required;
• Information on how to update the student’s immunization record;
• Information on how to submit a valid exemption; and
• Information on how to appeal the order.

Note: If the student’s immunization records are updated with Toronto Public Health and meet the requirements of the ISPA, the student can return to school when the order is lifted by Toronto Public Health. The student does not have to complete the full 20-day suspension period.

What should parents do if they have received a suspension order?

To ensure that a student is not suspended, parents or students aged 16 and 17 are responsible for reporting immunizations to Toronto Public Health. Health care providers, such as doctors or nurses, are not required to report vaccines to Toronto Public Health.
Parents or students aged 16 and 17 can report vaccines directly to Toronto Public Health through Immunization Connection Ontario (ICON) or call 416-338-7600 and select option two for immunization.

If parents received a suspension order:

1. Check the student’s yellow vaccine card to see if they received the required vaccines (or age-appropriate boosters).
   1. If the student has not received the required vaccines (or age-appropriate boosters), make an appointment with a health care provider to get vaccinated. Then, report the student’s vaccination record directly to Toronto Public Health, as indicated above.
   2. If the student already received the required vaccines, report the student’s vaccination record, as indicated above.
2. If you have already sent in student records to Toronto Public Health and are still receiving notification letters, please call 416-338-7600 and select option two for immunization.

When can a suspension order be lifted?

If a student received a suspension order, and comes into compliance before the suspension period begins, the suspension order will be lifted and the student will not be suspended.

Once a suspension period has begun, a student can return to school when:

• The requested vaccination information is submitted to Toronto Public Health and the student is now in compliance with the ISPA (up-to-date). Toronto Public Health will confirm the student can return to school; or
• A valid exemption is provided to Toronto Public Health and the student is in compliance with the ISPA. TPH will confirm the student can return to school; or
• The suspension period has ended (20 school days or as otherwise specified in the suspension order).

What is the process for appealing a suspension order?

Parents and students aged 16 and 17 have the right to appeal a suspension order and request a hearing with the Health Services Appeal Review Board (HSARB) within 15 days after the date the order is served. The HSARB is an independent adjudicative body established by provincial legislation to handle ISPA appeals.

To appeal a suspension order, the parent or student must notify the following parties of the intention to appeal in writing within 15 days of receiving the suspension order:

• Medical Officer of Health at immunization@toronto.ca,
• HSARB (see details below), and
• Principal of the student’s school

The HSARB currently recommends that all requests for appeal be sent via email to hsarb@ontario.ca or faxed to 416-327-8524. See Health Services Appeal and Review Board for up-to-date information.

Parents and students can contact Toronto Public Health if they have questions related to a student’s suspension.

Note: If parents or students aged 16 and 17 have been served with a suspension order and want to update the student’s record, please submit immunization records directly to Toronto Public Health at Immunization Connection Ontario (ICON) or at immunization@toronto.ca. Email is not a secure way to send health information but is an option.

Medical exemption documents can be submitted to immunization@toronto.ca.

For non-medical exemption documents, please mail your original commissioned Statement of Conscience or Religious Belief form and a copy of your education immunization certificate to:

Toronto Public Health,
Vaccine Preventable Diseases,
5100 Yonge Street, 2nd Floor,
Toronto, ON, M2N 5V7.

Do not send your immunization records to the HSARB. Contact them if you are appealing the suspension order and are requesting a hearing. Toronto Public Health may not receive records that are sent to the HSARB, resulting in a delay in updating the students’ vaccination record and lifting the suspension order so the student can return to school.

How much time does the student have to get up-to-date with the ISPA?

Toronto Public Health sends at least one notification letter, with a minimum of 4 weeks to respond, before sending a suspension order. Suspension periods begin a minimum of 4 weeks after the suspension order is sent. The dates that the suspension will start are listed on the suspension order. If the student is up-to-date with immunizations or a valid exemption before the suspension starts, the student will not be suspended.

If a student is suspended, will the suspension be on the student’s education record?

No, suspensions under the ISPA are not a part of a student’s education record. The purpose of the ISPA is to increase the protection of the health of children against the diseases that are designated diseases in the ISPA.

Toronto Public Health is hosting community clinics to help students catch-up on their school-based vaccines. Clinics are appointment based and residents are encouraged to book an appointment.

Immunization Connect Ontario (ICON) is a secure online provincial system used to track and report a child’s immunizations to Toronto Public Health.

To submit updates or view your child’s immunization record in ICON you will need one of the following:

• Your child’s Ontario Health Card (OHCN)

OR

• Your child’s Ontario immunization ID (OIID -10 digit #) found on the letter sent from Toronto Public Health

Parent’s using OIID for the first time:

If your child does not have an OHCN you will need to obtain an OIID and a PIN to submit and view the immunization into ICON. Please call 416-338-7600 and select option two for immunization to obtain an OIID and a PIN.

Refer to the How to enter immunizations into ICON guide for help in submitting student immunization information to Toronto Public Health. Once your child’s vaccination record is complete in ICON, you can access a copy of their vaccination record when needed. For example, ICON can generate an electronic yellow vaccination card when proof of vaccination is required.

Parents/guardians or students aged 16 and older are responsible for reporting student’s immunizations to public health every time the student gets a vaccine. Health care providers, such as doctors or nurses, are not required to report vaccines to Toronto Public Health. Refer to the How to enter immunizations into ICON guide for help in submitting student immunization information to Toronto Public Health.

Students 16 years and older:

• Can access their immunization record online using ICON found at toronto.ca/student vaccines. (Select “me” as accessing record)
• For parents to access the record, the student is required to provide consent by calling Toronto Health Connection at 416-338-7600 (select option 2).

By law, students aged 16 or older are required to give consent directly to Toronto Public Health if they want their parent/legal guardian to access or update their immunization record (Personal Health Information Privacy Act, 2004).

A student may be exempted from immunization under the ISPA for medical reasons or due to conscious or religious belief. To apply a valid exemption on your child’s immunization record for:

Medical exemptions

1. Download and print the Statement of Medical Exemption form.
2. Have a health care practitioner complete the form. Your health care practitioner will submit the necessary documentation back to Toronto Public Health.

Non-medical exemptions

1. Attend an immunization education session required by the ISPA and receive a certificate.
2. Complete the Statement of Conscience or Religious Belief form. Have the form signed before a Commissioner for Taking Affidavits. (Note: you may be charged a fee for this service).
3. Mail both certificate and notarized form back to:

Toronto Public Health
Vaccine Preventable Diseases
5100 Yonge Street, 2^nd Floor
Toronto, ON, M2N 5V7

Note: the education session must be completed by a parent and should be the same parent completing the Statement of Conscience or Religious form. To receive a Vaccine Education Certificate, your child(ren) must either live and/or attend school within the City of Toronto.

For more information on immunization exemptions call 416-338-7600 and select option two for immunization. To register for an upcoming session visit TPHBookings.ca and select Immunization Education Session.

If there is a vaccine preventable disease case or outbreak at your child’s school, your child might be excluded from school to keep them and their school safe.

For parents/legal guardians of children in a license child-care centre, if your child is not in grade school, there is a different form and process for an exemption. An immunization education session is not required. Please visit Information for Staff and Children for more information.

Who is a Commissioner for Taking Affidavits?

A parent must complete Statement of Conscience or Religious Belief form and have it witnessed by a Commissioner for Taking Affidavits. A Commissioner for Taking Affidavits is a person who can sign and swear or affirm. This form can be sign by:

• Lawyer, judge, justices of the peace – who practice in Ontario
• Notary public service
• Members of a municipal council (City Councillor)
• Members of the Provincial Parliament
• Call 211 for list of legal clinics

Toronto Public Health (TPH) receives immunization information in many languages other than English. If you are currently being assessed by TPH under the ISPA, please submit your foreign records for processing.

Parents/legal guardians and students 16 years of age and older can report their foreign record to TPH by submitting:

• Online using ICON.
• Mail a copy to:

Toronto Public Health
Vaccine Preventable Diseases
5100 Yonge Street, 2^nd Floor
Toronto, ON, M2N 5V7

• Fax to 416-338-2487.
• Email a copy to immunization@toronto.ca. Note that email is not a secure way to send health information but is an option.

For individuals that are not school aged, TPH recommends finding a settlement agency or community agency that offer translation services.

Learn more about the required vaccines (or to have a valid exemption) for children who attend childcare and school.

Learn more about tips to improve your child’s immunization experience.

Call Toronto Public Health at 416-338-7600 (language interpretation available) and select option two for immunization if:

1. Your child is now 16 years old, and you are locked out of your child’s ICON account.

A child’s ICON account automatically locks and requires a pin reset on a child’s 16th birthday, in accordance with the Personal Health Information Protection Act (PHIPPA). The child must call Toronto Health Connection at 416-338-7600 and select option two for immunization in order to reset their pin. Only one PIN can be used to access the ICON account. Therefore, the child must decide:

• • Keep sole access of their ICON account and take responsibility to submit immunization information
  • Give consent to TPH that parent(s) can have access to their account.

2. No Ontario Health Insurance Plan (OHIP) or Ontario Immunization Identification (OIID).
   Need to report vaccinations for your child in elementary/secondary school and you do not have either:

• • an Ontario Health Card or
  • an Ontario Immunization Identification.

Call Toronto Health Connection at 416-338-7600 and select option two for immunization to obtain your OIID #. Once you receive your OIID # then you will be able to create an account and report your immunizations.

All vaccines needed for school are free (publicly-funded). If your child does not have OHIP or health insurance, contact a clinic that provides free health care to uninsured people.

3. Trouble submitting vaccinations into ICON

If you are experiencing problems accessing ICON. Call Toronto Health Connection at 416-338-7600 and select option two for immunization for further guidance.

Learn more about the Province’s School Immunization Checklist and Vaccine Preventable Diseases .