School absenteeism leads to poor performance in school and reduced future health and socioeconomic outcomes. School nurses use their education and expertise to recognize and intervene in health-related problems affecting the learning environment. With a school nurse-led absence surveillance initiative, at-risk students can be identified early, families can be connected to appropriate resources, and students can be more closely monitored to determine the effectiveness of interventions and improved attendance. This project aimed to adapt and implement a process to consistently identify students with cluster health-related chronic absences using the NASN School Nurse-Led Active Surveillance Manual and document and evaluate the effectiveness of school nurse intervention. The Iowa Model and 21st Century Framework for School Nursing PracticeTM guided this project. Attendance data was collected for first-semester students of the 2022-23 school year and compared to first-semester students of the 2019-20 school year to evaluate if students with cluster health-related absences were identified and referred to the school nurse. In 2022-23, 233 students were eligible for referral based on the developed criteria, and 58 students were referred to the school nurse for cluster health-related absences compared to the 2019-20 school year, with 165 students eligible for referral and four students referred. Following the Active Surveillance Manual NASN toolkit steps, all students with cluster health-related absences received outreach to determine the need for support to return to school. A standard operating procedure was developed for the attendance clerk, school nurse, teachers, and administrators to improve consistency and accuracy of documentation, monitoring, and referral of chronically absent students. The project’s overall goal was to ensure accurate documentation, tracking, reporting, and follow-up for students with cluster health-related absences and identify students at higher risk of illness or injury to provide additional support or accommodations that allowed them to return to school.