Vaccination Audit Form - St Andrews 2025

St Andrews Lutheran College

Vaccination Audit Form
Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date of Birth
Mobile Phone Number*
Please enter a valid phone number.Format: 0000 000 000.
Email*
example@example.com
Gender*
Medicare Number (if you have one)
Ref No
IHI Number (if you have one)
If you aren't eligible for a Medicare number and don't have an IHI number, we strongly recommend that you apply for and IHI so that health professionals are confident that the right information is associated with the right individual at the point of care. You can apply for one at Services Australia.
This audit is to confirm your immunity status for the following:
- Hepatitis A
- Measles, mumps and rubella
- Varicella (chicken pox)
- Pertussis (whooping cough)
NoYes
Please upload any vaccination records you have.

Cancelof
NoYes
Blood test results

Please upload any blood test results you have. It is not necessary to contact your doctor for these records.
Cancelof
I consent to the preparation of my immunisation history by VaxWorks Health Services. I understand that this information will include details of my vaccination records and may be shared with my employer as part of their health and safety requirements. I acknowledge that this consent is given voluntarily and that I may withdraw my consent at any time by notifying VaxWorks Health Services in writing. I understand that my immunisation history will be shared strictly in accordance with privacy laws and regulations.
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St Andrews Lutheran College