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Apply for the Influenza Vaccination Honor Roll

Tell Us about Influenza Vaccination Mandates for Healthcare Personnel

IAC is recognizing the stellar examples of influenza vaccination mandates in healthcare settings. According to New York State Health Commissioner Richard Daines, MD, "The rationale begins with the healthcare ethic, which is: The patient's well-being comes ahead of the personal preferences of healthcare workers."

CRITERIA FOR INCLUSION: To be included in the Influenza Vaccination Honor Roll, the mandate you are reporting must require influenza vaccination for employees and must include serious measures to prevent transmission of influenza from unvaccinated workers to patients. Such measures might include a mask requirement, reassignment to non-patient-care duties, or dismissal of the employee.

Fill out this form and then click the "Send to IAC" button at the bottom of the page.

Contact Information
Your First Name:  
Your Last Name:  
Job Title:  
Organization Name:
(that is implementing the mandate)
Organization Type:
"Other" Org. Type or State Name:  
Zip Code:  
Your Phone:  
Email Address:  
Confirm Email Address:  
Second Email Address:  
Confirm 2nd Email Address:  
Mandate Information

Can employees opt out of receiving
influenza vaccination for medical reasons?

 Yes  No  Don't Know

Can employees opt out of receiving
influenza vaccination for religious reasons?

 Yes  No  Don't Know

Can employees opt out of receiving
influenza vaccination for reasons other
than medical or religious?

 Yes  No  Don't Know

Please indicate which consequences apply
if the employee refuses vaccination.
Check all that apply:

 Wearing a mask at all times while at work during influenza season
 Don't know
 Other. Please specify:

Please tell us who is covered by the mandate :
  All healthcare workers employed

  in the facility

 Yes  No  Don't Know

  All healthcare workers who come into the
  facility to see patients (e.g., all non-hospital-
  based physicians)

 Yes  No  Don't Know

  All healthcare workers with patient contact

 Yes  No  Don't Know

  Clerical staff

 Yes  No  Don't Know

  Janitorial staff

 Yes  No  Don't Know

  Laboratory staff

 Yes  No  Don't know  Not applicable

  Dietary staff

 Yes  No  Don't know  Not applicable

  People who volunteer in the facility

 Yes  No  Don't know  Not applicable

Approximately how many people are covered
by this mandate? (Enter integers only.)


What is/was the implementation date?
(Provide precise MM/DD/YY if known.)


Please provide any additional information
about the mandate including groups other
than those mentioned above for whom
influenza vaccine is mandated:


Please provide Internet links to any
information about the mandate, such as
press releases or organization web page:


There may be a delay after sending. Please be patient.

You will receive an email message containing a copy of the information entered here.
Thank you for helping with this important project!

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This website is supported in part by a cooperative agreement from the National Center for Immunization and Respiratory Diseases (Grant No. 5U38IP000589) at the Centers for Disease Control and Prevention (CDC) in Atlanta, GA. The website content is the sole responsibility of IAC and does not necessarily represent the official views of CDC.