F883 influenza and pneumococcal immunizations: a survey checklist
Short answer: F883 is the survey tag for 42 CFR 483.80(d)(1) and (2). For flu and pneumococcal vaccines, the home must teach each resident (or their representative) about the benefits and side effects, offer the shot, let them refuse, and write it all in the medical record. Flu is offered October 1 through March 31 each year. Surveyors pick five residents and read their records for the education, the offer and the outcome. Here is what they look for, and a checklist to run before survey.
Updated October 22, 2026 · Checked against the official sources listed at the end
What the rule requires
Both parts of the rule have the same four steps. The home must have policies and procedures that make sure of each one.
- Education first: before the shot is offered, the resident or their representative learns the benefits and possible side effects.
- The offer: flu every year from October 1 through March 31, and pneumococcal once the resident is eligible, unless it is medically contraindicated or the resident is already immunized.
- The right to refuse: the resident or representative can say no.
- The record: the medical record shows, at a minimum, that the education was given and that the resident got the shot, or didn't because of a medical contraindication or a refusal.
How surveyors check it
CMS's guidance to surveyors (State Operations Manual, Appendix PP) tells them to select five residents in the sample and review them for flu and pneumococcal immunizations. They read each record for education, and for the shot given, refused or medically contraindicated. If needed, they check that your policies exist.
Under that guidance, a surveyor will generally cite F883 when the home failed to do one or more of these: keep and follow vaccine policies that match national standards; vaccinate an eligible resident who hadn't had the shot, refused or had a contraindication; let the resident refuse; give and document the education; or document the shot, the refusal, the contraindication or an earlier vaccination.
Most F883 citations are at the low end of the severity scale. In CMS's Health Citations file (September 2026, counted by Pact), F883 was cited 2,946 times at 2,599 homes, and 10 of those citations reached actual harm or worse. A citation still means a written deficiency and a plan of correction.
Flu season timing
The rule says October 1 through March 31. CMS's guidance adds that CDC finds it most effective to give the vaccine when it arrives each season, not on a set date, so offer it when your supply comes in.
Residents admitted late in the season (often February or March) should still be offered the flu vaccine, because late outbreaks happen. If a resident is admitted outside flu season, CMS doesn't expect an offer, though you may make one.
If there is a vaccine shortage, surveyors ask you to show that you ordered the vaccine, have a plan for giving it, screened residents to see who is eligible and wants it, and started the education.
Proof of an earlier shot
CMS's guidance says to accept only written, dated records as proof of earlier vaccines, with two exceptions: a resident's own report of a flu shot or of the pneumococcal polysaccharide vaccine (PPSV) is acceptable. A representative who knows the resident's care can report for them. Your state may be stricter.
If the record suggests a pneumococcal vaccine was given but the date can't be checked, and that affected the decision, note it in the medical record.
Tennessee adds deadlines
Tennessee's nursing home rule (Tenn. Comp. R. & Regs. 0720-18-.06) is stricter on timing. Flu shots for residents who accept must be done by November 30 each year, or within ten days of the vaccine becoming available. Residents admitted later in the season, up to February 1, should be vaccinated on admission unless they refuse. The home must provide or arrange the pneumococcal vaccine for residents 65 and older who weren't immunized before admission, unless they refuse.
The same rule sets a staff flu program: a no-cost offer to staff, a signed declination from anyone who refuses for non-medical reasons, staff education, and a yearly evaluation of the program.
COVID-19 and RSV are separate
COVID-19 vaccine has its own paragraph, 483.80(d)(3), and its own survey tag, F887. It follows the same pattern: education, an offer when vaccine is available to the facility, the right to accept or refuse, and documentation of each dose or the reason none was given.
RSV is not in 483.80(d). There is no federal duty to offer it, but resident RSV vaccination is part of the weekly NHSN report. CDC's adult schedule recommends RSV vaccine for everyone 75 and older, and for adults 50 to 74 at higher risk.
Pre-survey checklist
- ☐ Written flu and pneumococcal policies, approved by the medical director, that match current CDC and ACIP schedules.
- ☐ Physician-approved orders for flu and pneumococcal vaccine, with an assessment of each resident for contraindications.
- ☐ For every resident: the date education was given, and to whom (the resident or the representative).
- ☐ For every resident: the date the shot was offered.
- ☐ The outcome: given (date, vaccine, lot if you record it), refused (a signed declination if your policy uses one) or medically contraindicated (the reason).
- ☐ Written, dated proof for any shot given elsewhere (self-report is fine only for flu and PPSV).
- ☐ New admissions and readmissions during flu season offered the flu vaccine.
- ☐ A list of residents still due, so nobody admitted mid-season is missed.
- ☐ Tennessee homes: flu offers done by November 30 or within ten days of the vaccine arriving.
- ☐ Pick five residents at random and check their records yourself, the way a surveyor will.
How Pact helps
Pact's resident immunization tracking keeps the education, the offer and the outcome for each resident's flu, pneumococcal, COVID-19 and RSV vaccines, with the signed declination when a resident refuses. A due list shows who still needs an offer and why: the flu season, the Tennessee November 30 date, age, and readmission. On clinic day you enter a whole hall at once. You can upload your EHR's vaccine report and Pact shows what doesn't match. For survey, print the record for any five residents.
Pact doesn't give or order vaccines, doesn't decide who gets one, and doesn't replace your chart. Your nurses and medical director make those calls. No tool can promise a survey result.
See also: Resident immunization tracking · Weekly NHSN reporting · Free in-service training for staff
Common questions
How many residents do surveyors review for F883?
CMS's guidance tells surveyors to select five residents in the sample and review their records for flu and pneumococcal education, and for the shot given, refused or medically contraindicated.
When must nursing homes offer the flu vaccine?
Each year from October 1 through March 31 under 42 CFR 483.80(d)(1). CMS's guidance says to give it when the vaccine arrives, and to offer it to residents admitted late in the season. Tennessee wants accepting residents vaccinated by November 30 or within ten days of the vaccine arriving.
Is a verbal refusal enough?
The rule requires the refusal to be documented in the medical record. Many homes have the resident or representative sign a declination, so the record shows it was their choice after education.
Does a resident's word count as proof of an earlier shot?
For flu and the pneumococcal polysaccharide vaccine (PPSV), yes, under CMS's guidance. For other vaccines, accept only written, dated records.
Does F883 cover COVID-19 or RSV?
No. COVID-19 is 483.80(d)(3), surveyed under F887. RSV has no federal offer rule, but resident RSV vaccination is part of the weekly NHSN report.
Does F883 cover staff flu shots?
No, F883 is about residents. Staff flu vaccination is reported once a year to NHSN for CMS's quality reporting program, and some states, like Tennessee, set their own staff flu program rules.
Sources
- CMS State Operations Manual, Appendix PP, F883 (Rev. 225)
- 42 CFR 483.80(d), Influenza, pneumococcal and COVID-19 immunizations (eCFR)
- Tenn. Comp. R. & Regs. 0720-18-.06, Basic services (nursing homes) (Cornell LII)
- CMS Health Citations dataset (Provider Data Catalog)
- CDC adult immunization schedule by age