Survey Intent

This survey is designed to be completed by the person responsible for scheduling COVID-19 vaccinations for an agency or organization in Van Buren or Cass County. This survey collects information for the entire agency/organization and identifies a Point of Contact. 

Question Title

* 1. Agency/Organization Name

Question Title

* 2. County agency/organization is located

Question Title

* 3. What discipline does your organization belong to?

Question Title

* 4. Total number of employees

Question Title

* 5. How many employees are interested in recieving the COVID vaccine when it becomes available?

Question Title

* 6. Does your agency/organization have an occupational health or other medically trained professional available to administer vaccine to your employees?

Question Title

* 7. Please list any planning considerations for your organization that you think we should know? i.e. shifts, weekend schedules, multiple sites, etc. 

Question Title

* 8. Please provide the name and contact information for the person responsible for employee health. 

T