COVID Vaccine

PLEASE NOTE:
  • Only one survey should be filled out per agency/employer. 
  • Prior to survey completion you will need to poll your staff to have a definite number of those willing to accept the COVID vaccine.
  • Due to unpredictability of vaccine supply, we will NOT be providing estimated dates for vaccination.
  • The health department will contact you as more information is available for your business vaccination.

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* 1. Business Name

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* 2. Primary Contact for COVID Vaccine Communications

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* 3. Business Type

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* 4. After polling your staff, how many will be accepting the vaccine that have direct contact with the public?

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* 5. After polling your staff, how many will be accepting the vaccine that do not have contact with the public?

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