The Bottom Line: What You Need to Know
If you run a daycare in Florida, immunization compliance is one of the non-negotiable parts of your job. Florida law — specifically Florida Statute 402.305 and Florida Administrative Code Rule 64D-3.046 — requires that every child enrolled in a licensed child care facility must have a current immunization record on file. No exceptions to the documentation requirement, period.
Here's the rule in its simplest form: before a child can attend your daycare, their file must contain either a completed Form DH 680 (the state immunization certification) or a Form DH 681 (religious exemption). One or the other. Every child. Every file. If an inspector opens a child's folder and neither form is there, you have a violation.
The good news: you are not the one who decides whether a child's vaccines are up to date. That's the doctor's job. The doctor fills out Form DH 680. Your job is to collect that form, verify it's complete and current, and keep it in the child's file. You're a record-keeper, not a medical professional.
The bad news: if the form is missing, incomplete, or expired when the inspector comes, that's your problem — not the parent's, not the doctor's. Yours.
This guide walks through every vaccine Florida requires for daycare enrollment, explains the forms you need, breaks down how exemptions work, covers what happens during an inspection, and gives you a printable checklist to make sure every file in your facility is inspection-ready. We've also included a section on the 2026 legislative changes that may affect these requirements.
Every Required Vaccine, Explained
Florida requires children in licensed child care facilities to be immunized against seven categories of disease. Below is each required vaccine, what it protects against in plain English, and why the state requires it. The specific vaccine requirements are codified in the Immunization Guidelines for Florida Schools, Childcare Facilities, and Family Day Care Homes (DH Form 150-615), which is incorporated by reference into Rule 64D-3.046.
The Florida Department of Health has proposed removing four of these vaccines (Hepatitis B, Varicella, Hib, and PCV) from the required list through rulemaking. As of April 2026, that rulemaking process is not finalized, and all seven vaccines listed below remain required. See the 2026 Legislative Update section for details.
| Vaccine | Protects Against | Why It Matters | Common Brand Names |
|---|---|---|---|
| DTaP | Diphtheria, tetanus, and pertussis (whooping cough). Three diseases in one shot. Pertussis is highly contagious and especially dangerous for infants. | Whooping cough spreads fast in group settings. Tetanus comes from cuts and scrapes — common in daycare. Required by Florida statute. | Daptacel, Infanrix, Pediarix (combo), Pentacel (combo) |
| IPV | Polio (poliomyelitis). A virus that can cause paralysis and death. The inactivated polio vaccine is given as a shot. | Polio was once the most feared childhood disease. The vaccine nearly eradicated it worldwide. Required by Florida statute. | IPOL, Pediarix (combo), Pentacel (combo), Kinrix (combo) |
| MMR | Measles, mumps, and rubella (German measles). Three viral diseases in one shot. Measles is extremely contagious and can be fatal. | A single measles case in a daycare can infect nearly every unvaccinated child in the building. Required by Florida statute. | M-M-R II, Priorix |
| Hepatitis B | Hepatitis B virus, which causes serious liver disease. Spread through blood and body fluids. | Children can carry the virus without symptoms and spread it through scratches, bites, or shared items with blood on them. | Engerix-B, Recombivax HB, Pediarix (combo) |
| Varicella | Chickenpox (varicella-zoster virus). Causes an itchy rash with blisters, fever, and tiredness. Can cause serious complications in young children. | Chickenpox is airborne and extremely contagious in daycare settings. One case can shut down a classroom. Not required if the child has a documented history of chickenpox from a physician. | Varivax, ProQuad (combo with MMR) |
| Hib | Haemophilus influenzae type b, a bacterium that can cause meningitis (infection around the brain), pneumonia, and a severe throat infection called epiglottitis. Despite the name, it's not the flu. | Hib was once the leading cause of bacterial meningitis in children under 5. It spreads through coughing and sneezing. | ActHIB, PedvaxHIB, Pentacel (combo), Vaxelis (combo) |
| PCV | Pneumococcal disease (Streptococcus pneumoniae), which can cause meningitis, blood infections, ear infections, and pneumonia in young children. | Pneumococcal bacteria are a leading cause of ear infections and meningitis in children under 2. Daycare attendance increases risk significantly. | Prevnar 20 (PCV20), Vaxneuvance (PCV15) |
What about Hepatitis A?
Florida does not require the Hepatitis A vaccine for daycare or school entry. The CDC recommends it, and most pediatricians give it (typically two doses starting at age 1), but it's not on Florida's required list for child care facilities. If a parent asks, you can tell them it's recommended but not required for enrollment.
What about the flu shot?
Florida does not require the influenza (flu) vaccine for daycare enrollment. However, Florida Statute 402.305 does require you to distribute information about the flu vaccine to parents during August and September each year. This is an education requirement, not a vaccination requirement — but it is something inspectors check.
Doses Required by Age at Enrollment
The number of vaccine doses a child needs depends on their age. A 3-month-old enrolling in your infant room has different requirements than a 4-year-old starting in your pre-K class. The schedule below follows the Florida DOH immunization guidelines, which align with the CDC's recommended immunization schedule.
Important: You don't need to memorize this table. The child's doctor determines whether the child is up to date and documents it on Form DH 680. But understanding this schedule helps you spot problems — like when a parent hands you a form that seems light on doses for a 4-year-old.
Infants and toddlers (ages 2 months through 23 months)
For children under 2, vaccines are given in a series of doses spaced out over the first year and a half of life. The number of doses a child should have depends on exactly how old they are at enrollment. Here's the minimum number of doses typically completed by each milestone:
| Age at Enrollment | DTaP | IPV (Polio) | Hep B | Hib | PCV | MMR | Varicella |
|---|---|---|---|---|---|---|---|
| 2 months | 1 | 1 | 1 | 1 | 1 | — | — |
| 4 months | 2 | 2 | 1-2 | 2 | 2 | — | — |
| 6 months | 3 | 2-3 | 2 | 2-3 | 3 | — | — |
| 12 months | 3 | 3 | 2-3 | 3 | 3-4 | 1 | 1 |
| 15–18 months | 4 | 3 | 3 | 3-4 | 4 | 1 | 1 |
You'll notice some ranges (like "2-3" or "3-4") in the table above. That's because the exact number of doses depends on which brand of vaccine the doctor used and at what age the series started. For example, the Hib vaccine from one manufacturer requires 3 doses while another requires 4. The doctor accounts for this on Form DH 680 — you don't need to figure it out yourself.
Preschool age (2 through 4 years old)
By the time a child is 2 years old, most of the primary series is complete. The remaining requirements are booster doses to maintain protection:
| Age at Enrollment | DTaP | IPV (Polio) | Hep B | Hib | PCV | MMR | Varicella |
|---|---|---|---|---|---|---|---|
| 2–3 years | 4 | 3 | 3 | 3-4 | 4 | 1 | 1 |
| 4–5 years (pre-K) | 4-5 | 3-4 | 3 | Complete | Complete | 2 | 2 |
At the 4-5 year mark, children typically receive their final booster doses of DTaP and IPV, plus a second dose of MMR and varicella. This is the "kindergarten readiness" round of shots. If a child is in your pre-K room, they should be completing or have completed this round.
"Complete" for Hib and PCV means the child has finished the full age-appropriate series. These vaccines are not required past the recommended schedule (usually completed by 15-18 months for Hib, and 12-15 months for the PCV primary series with a booster).
You do not determine whether a child is up to date on their vaccines. The doctor does. Your job is to ensure the DH 680 form is in the file, that it's signed by a provider, and that it's current. If the form says the child is up to date, the child is up to date. If the form shows a Temporary Medical Exemption with an expiration date, note that date and follow up before it expires.
Form DH 680: The Document That Matters Most
Form DH 680 — the Florida Certification of Immunization — is the single most important document in every enrolled child's file. It's the state's official proof that a child has received their required vaccinations. Without it, the child cannot legally attend your facility.
What it is
The DH 680 is a standardized form used statewide. It lists every vaccine the child has received, the dates each dose was administered, and whether the child is fully up to date or has a temporary medical exemption. It's the only acceptable documentation — a printed vaccine record from a doctor's office or a card from another state does not count. It must be on the Florida DH 680 form specifically.
Who fills it out
A licensed healthcare provider (physician, nurse practitioner, or physician assistant) completes and certifies the form. Daycare staff never fill out this form. If a parent says their child's vaccines are up to date but doesn't have the DH 680, the parent needs to go back to their doctor and get it.
How it gets to you
There are three ways you'll typically receive a DH 680:
- Paper form from the parent: The most common method. The parent gets the form from their child's doctor and brings it to you.
- Electronic via Florida SHOTS: If your facility is enrolled in Florida SHOTS (the state's immunization registry), you can pull up certified DH 680 forms electronically. More on this in the Florida SHOTS section.
- Parent prints from home: If the child's doctor is enrolled in Florida SHOTS and has issued a Parent PIN, parents can print their own certified DH 680 from home.
What to check when you receive one
- Child's full legal name is on the form and matches your enrollment records Watch for nicknames or abbreviated names that don't match
- Child's date of birth is listed and correct
- The form is signed by a licensed healthcare provider (or has an electronic certification) Look for "certified with electronic signature" for Florida SHOTS forms
- All age-appropriate vaccines are documented with dates administered
- If there's a Temporary Medical Exemption (TME), it has a clear expiration date Calendar the expiration date immediately — you need an updated form before it expires
- If there's a Permanent Medical Exemption, it includes a written explanation from the physician
- The form is current — not outdated with a child still needing additional doses A DH 680 from when the child was 6 months old won't be current when the child is 2 years old
Where to get the form
The DH 680 is available from any healthcare provider enrolled in Florida SHOTS or from the county health department. Parents can also access it through the Florida SHOTS patient portal if their provider has issued them a PIN.
A printout from a doctor's EMR system is not a DH 680. A vaccine card from another state is not a DH 680. A hand-written list of vaccines is not a DH 680. The inspector will only accept the official Florida Form DH 680 (or Form DH 681 for religious exemptions). If a parent gives you anything else, you need to explain that Florida requires this specific form and direct them to their healthcare provider or the county health department to get it.
Exemptions: Medical, Religious, and What's Changing
Not every child in your daycare will have a completed DH 680 showing all vaccines. Florida law allows two types of exemptions, each with its own form and rules. Understanding these is critical because an exempted child is still in compliance — as long as the proper exemption paperwork is on file.
Documented directly on the DH 680 form by the child's physician. There are two sub-types:
Temporary Medical Exemption (TME): For children who are in the process of completing their vaccines. The doctor writes an expiration date on the form. The child can attend while catching up. You must track the expiration date.
Permanent Medical Exemption: For children who cannot receive one or more vaccines due to a medical condition (such as a severe allergic reaction or immune disorder). The doctor must document the specific medical reason in writing on the form, "based on valid clinical reasoning or evidence."
For parents who object to immunizations based on their religious beliefs. This form is:
- Issued only by the county health department — not by doctors, not by the daycare, not by anyone else
- Requires the parent to appear in person with the child's birth certificate and parent ID
- The parent signs a statement affirming a sincerely held religious belief that conflicts with immunization
- The county health department must issue the form upon request — they cannot refuse it or interrogate the parent's beliefs
What Florida does NOT allow
As of April 2026, Florida does not allow philosophical or personal belief exemptions. A parent cannot simply say "I don't want my child vaccinated" and have that count. The exemption must be either medical (documented by a doctor) or religious (documented through the county health department process).
The Florida Senate passed SB 1756 in March 2026, which would have added a "conscience exemption" — essentially a personal belief exemption. However, the bill failed to advance in the House before the legislative session ended on March 13, 2026. If a similar bill passes in a future session and is signed by the governor, this section will need to be updated. See the full legislative update below.
How exemptions affect your compliance
From an inspection standpoint, a properly documented exemption is just as valid as a completed immunization record. If a child's file has a DH 681 (religious exemption), the inspector will note it and move on. You are not in violation.
There is one important caveat: during a disease outbreak, children with religious exemptions may be excluded from attending your facility. The Florida Department of Health can order unvaccinated children to stay home during an outbreak of a vaccine-preventable disease. This is rare, but it happens. If you have children with religious exemptions, you should have a plan for how you'll handle this scenario, including your tuition and attendance policies.
Provisional Enrollment and Catch-Up Rules
One of the most common questions daycare owners ask: "Can a child start at my facility if they haven't finished all their vaccines yet?" The answer is yes, with specific conditions.
Temporary Medical Exemption (TME)
If a child has started their vaccine series but hasn't completed it yet, their healthcare provider can issue a Temporary Medical Exemption on Form DH 680. Here's how it works:
- The provider documents which vaccines the child has received so far
- The provider writes an expiration date on the form — this is the date by which the child's next dose is due
- The child can attend your facility with the TME on file
- When the TME expires, you need an updated DH 680 showing the next dose was given (or a new TME with the next expiration date)
- If the TME expires and no updated form is provided, the child is out of compliance
The 30-day grace period for transfers and special cases
Florida Rule 64D-3.046 allows a temporary exemption of up to 30 days, issued by an authorized school official, for three specific categories:
- Homeless children
- Transfer students (children transferring from another facility or state who need time to obtain records)
- Children in the juvenile justice system
This 30-day window is meant to prevent these children from being turned away while their paperwork catches up. But it's a narrow exception — it does not apply to families who simply haven't gotten around to vaccinating their child.
Create a simple tracking system for every child with a TME or 30-day grace period. Note the child's name, the expiration date of their current exemption, and what's needed next. Check this list weekly. Contact parents 2 weeks before expiration to remind them to schedule their child's appointment. Document your reminders. If the expiration passes without an update, you need to follow your facility's policy — which should be clearly stated in your enrollment agreement.
What the Inspector Checks
When a DCF Licensing Counselor shows up for your routine inspection, immunization records are one of the specific things they review. Here's exactly what happens and what they're looking for.
The inspection form
The inspector uses the CF-FSP 5316 (Standards Classification Summary) form, which organizes the entire inspection into 32 categories. Immunization records fall under the health records category. The inspector will:
- Select a sample of children's files to review (they don't always check every single file, but they can)
- Open each file and look for Form DH 680 or Form DH 681
- Verify the form is complete, signed, and current
- Check that the vaccines documented on the form are age-appropriate for the child
- If a TME is present, check whether it has expired
What counts as a violation
| What's Missing | Violation? | Typical Class | What Happens |
|---|---|---|---|
| No DH 680 or DH 681 in the child's file | Yes | Class 3 | Corrective action required; fines start at $25 on 3rd occurrence |
| DH 680 is present but incomplete (missing doses for child's age) | Yes | Class 3 | Same as above — incomplete counts as non-compliant |
| TME on file but expired | Yes | Class 3 | You knew the date and let it lapse — inspectors note this |
| DH 681 (religious exemption) on file | No | — | Valid alternative to DH 680; child is compliant |
| Out-of-state vaccine record (not on DH 680) | Yes | Class 3 | Florida requires the Florida-specific form |
| DH 680 present and current | No | — | You pass this item |
How violations escalate
Immunization record violations are typically Class 3 violations under the CF-FSP 5316 classification system. Here's what that means:
- First offense: Corrective action plan required. No fine.
- Second offense: Corrective action plan required. No fine, but it's now a pattern.
- Third offense: Fine of $25 per violation. This is where it starts to cost money.
- Continued offenses: Fines escalate. Repeated Class 3 violations demonstrate a pattern of non-compliance, which can affect your license renewal.
A $25 fine might seem trivial. But every violation goes into the CARES database, which is publicly searchable at caressearch.myflfamilies.com. Parents research facilities before enrolling their children. A pattern of immunization record violations signals disorganization, and that's the kind of thing that costs you enrollment — which is far more expensive than $25.
Don't wait for the inspector to find problems. Run your own quarterly file audit. Open every child's file. Check for the DH 680 or DH 681. Check every TME expiration date. Make a list of anything missing and start calling parents the same day. An inspector who opens 10 files and finds 10 complete immunization records is an inspector who moves on to the next category without writing anything up.
Staff Health Requirements
Here's a question daycare owners often ask: "Do my employees need to be vaccinated?" The short answer: no specific vaccinations are required for child care workers in Florida. But there are health screening requirements you need to know about.
TB screening is required
Under Florida Administrative Code 65C-22, every child care employee must complete a health screening that includes a tuberculosis (TB) test. Here are the specifics:
- When: Within one year before or seven days after starting employment
- Method: Either a Mantoux skin test (TST) or an IGRA blood test (such as QuantiFERON or T-SPOT)
- After the initial test: Repeat testing is not required unless directed by a physician, physician assistant, CRNP, the Department of Health, or a local health department
- Volunteers: Must also have TB test results within one year before or seven days after their first presence in the center
General health screening
Beyond the TB test, each child care employee must have a health screening report signed by the person who performed the screening. This report must indicate:
- The employee's physical qualifications to perform their assigned duties
- The presence of any health condition that would create a hazard to the employee, children, or other staff members
No vaccine mandates for staff
Florida does not require child care workers to be vaccinated against measles, flu, COVID-19, or any other disease as a condition of employment. This is a state-level policy decision. Some large childcare chains or Head Start programs may have their own internal policies, but the state doesn't mandate it.
While staff don't need vaccines, inspectors will check that every employee's file contains their TB test results and health screening report. A missing TB test result is a violation, just like a missing DH 680 in a child's file. Include this in your quarterly file audits.
Florida SHOTS: The State Tracking System
Florida SHOTS (State Health Online Tracking System) is the state's free, centralized immunization registry. It's the backend system that powers much of what we've been talking about — and if you're not using it yet, you should be.
What it does for daycare owners
- Look up immunization records: Search for any child's records by name and date of birth, 24 hours a day, 7 days a week
- Print certified DH 680 forms: No more chasing parents for paperwork. If the child's provider has entered their records into Florida SHOTS, you can pull and print an electronically certified DH 680 directly
- Check transfer records: When a child transfers from another facility in Florida, their records are already in the system
- Verify religious exemption status: Check whether a DH 681 has been issued for a child, which helps during outbreak exclusion situations
- Reduce enrollment bottlenecks: No more waiting for parents to bring forms during peak enrollment periods
How to enroll your facility
Child care facilities can enroll in Florida SHOTS for free. There are two access levels:
- View-Only Account: Lets you look up records and print DH 680 forms. This is what most daycares need.
- Full-Access Account: Lets you also enter immunization data. Typically used by facilities with on-site health services.
To get started, visit flshotsusers.com/schools-and-child-care or call 877-888-7468. You can also email [email protected] for enrollment assistance.
If you're still collecting paper DH 680 forms from every parent, Florida SHOTS is a game-changer. Enroll in the system, get your view-only account, and start pulling records directly. You'll cut your enrollment paperwork time significantly, and you'll never have to hear "I forgot to get the form from the doctor" again. You can just look it up yourself.
2026 Legislative Update: What's Changing (and What Isn't)
If you've been following the news, you know that Florida's immunization requirements have been a hot topic since September 2025. Here's what's actually happening, stripped of the political noise, as of April 2026.
The September 2025 announcement
On September 3, 2025, Florida Surgeon General Dr. Joseph Ladapo announced plans to remove four vaccines from the required list for school and daycare entry through the Department of Health's rulemaking authority:
- Hepatitis B
- Varicella (chickenpox)
- Hib (Haemophilus influenzae type b)
- PCV (pneumococcal conjugate)
These four vaccines were added to Florida's requirements through administrative rule (Rule 64D-3.046), not by statute. That means the Department of Health can modify them through the rulemaking process without needing the legislature to pass a law.
The rulemaking process
The DOH held a public workshop on December 12, 2025, in Panama City Beach, to discuss proposed revisions to Rule 64D-3.046. The workshop drew about 90 attendees and significant national media attention. However, the rulemaking process has not been completed. As of April 2026:
- No formal Notice of Proposed Rulemaking has been filed
- Required public workshops in major population centers have not been scheduled
- The rule change is not in effect
The legislative effort
In parallel, the Florida Senate passed SB 1756 (the "Medical Freedom Act") in March 2026. This bill would have:
- Added a "conscience exemption" for parents who object to vaccines based on personal beliefs (not just religious beliefs)
- This would have applied to both K-12 schools and child care facilities
However, SB 1756 failed to advance in the Florida House before the legislative session ended on March 13, 2026. The bill did not become law.
What remains required
Three vaccines — DTaP (diphtheria, tetanus, pertussis), IPV (polio), and MMR (measles, mumps, rubella) — are required by Florida statute (specifically, Sections 1003.22 and 402.305). These cannot be removed by the Department of Health through rulemaking. Removing them would require the legislature to pass a new law.
What this means for you right now
Until and unless the rulemaking process is completed or new legislation is signed, all seven vaccines remain required, and the only valid exemptions are medical (DH 680) and religious (DH 681). Do not stop requiring any vaccine based on news reports about proposed changes. If an inspector walks in tomorrow, they will be checking against the current requirements — not proposed ones.
We will update this guide when any changes are finalized. Bookmark this page and check back periodically.
Your Immunization File Checklist
Use this checklist for your quarterly file audits. Open every child's file and make sure each item below is present and current. If anything is missing, contact the parent that day.
- Form DH 680 (Certification of Immunization) OR Form DH 681 (Religious Exemption) is present in the file One or the other — every child, no exceptions
- Child's full legal name on the form matches enrollment records
- Child's date of birth on the form matches enrollment records
- Form is signed by a licensed healthcare provider (or electronically certified via Florida SHOTS)
- All age-appropriate vaccines are documented with dates administered
- If a Temporary Medical Exemption (TME) exists, the expiration date has not passed If it has passed, contact the parent immediately for an updated form
- If a Permanent Medical Exemption exists, the physician's written explanation is included
- If a DH 681 (religious exemption) is on file, verify it was issued by the county health department Should have the county health department seal/stamp
- Form has been updated since the child's last vaccine milestone age (see dose tables above)
- No substitute documents accepted in place of official DH 680 or DH 681 forms
- Every enrolled child has either a DH 680 or DH 681 in their file
- A tracking system is in place for children with Temporary Medical Exemptions (TME expiration dates)
- Flu vaccine information has been distributed to parents during August/September (per FS 402.305) Keep a copy of the handout and a record of distribution dates
- Facility is enrolled in Florida SHOTS (recommended, not required) Visit flshotsusers.com or call 877-888-7468
- Every staff member's file contains TB test results (Mantoux or IGRA) Must be within 1 year before or 7 days after hire date
- Every staff member's file contains a signed health screening report
- Every volunteer's file contains TB test results
- Enrollment agreements clearly state your immunization documentation policy and consequences for non-compliance
Official Resources and Links
Below are the official sources referenced throughout this guide. Bookmark these — they're the primary references you'll need for staying current on Florida's immunization requirements.
Forms and documents
Laws and regulations
State systems and support
About ComplianceKit
ComplianceKit is compliance management software built specifically for child care facilities. It automates the tracking and documentation that consumes hours of your week: immunization record tracking with automatic TME expiration alerts, staff TB test and training expiration monitoring, fire drill documentation, ratio monitoring, and everything else that shows up on the CF-FSP 5316.
Instead of spreadsheets, sticky notes, and hoping you don't forget something, ComplianceKit gives you a single dashboard that shows your compliance status in real time. When a child's TME is about to expire or a staff member's TB test is due, you know about it before the inspector does.
Built by people who've been through the inspection process and got tired of the stress. Now used by hundreds of Florida child care facilities to stay inspection-ready every day of the year.
Learn more about ComplianceKit