Will you be negatively impacted by the comprehensive mandatory vaccinations by 8 November 2021?

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* 1. What is your postcode where your service is operating in?

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* 2. How many of the following staff does your service currently employ?

Staff who work directly with children?

Staff who DO NOT work directly with children?

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* 3. How many of the following staff do you believe WILL NOT BE fully vaccinated by 8 November 2021?

Staff who work directly with children?

Staff who DO NOT work directly with children?

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* 4. Of those you believe WILL NOT BE fully vaccinated by 8 November 2021 AND are staff who WORK DIRECTLY with children, how many align to the following situations/choices?

Choosing not to

Can't get an appointment

Medical reason(s) that a health practitioner WILL issue the required exemption

Medical reason(s) that a health practitioner WILL NOT issue the required exemption

Other

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* 5. Of those you believe WILL NOT BE fully vaccinated by 8 November 2021 AND are staff who DO NOT WORK DIRECTLY with children, how many align to the following situations/choices?

Choosing not to

Can't get an appointment

Medical reason(s) that a health practitioner WILL issue the required exemption

Medical reason(s) that a health practitioner WILL NOT issue the required exemption

Other

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* 6. If you used "OTHER" in Q4 & Q5, what are the OTHER reason(s)?

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* 7. Please provide any queries, comments, advice, suggestions that may be useful in ACA NSW's advocacies with the NSW Government:

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* 8. OPTIONAL & CONFIDENTIAL: If you would like ACA NSW to contact you to discuss your concerns, please complete the following:

Full Name

Service Name

Position

City/Town/Suburb

E-mail Address

Telephone/Mobile Number