Has your organization been
listed on the Honor Roll
previously? Check Immunize.org's list of
existing
honorees for
your institution. Are you already listed? |
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Additional information
you wish to share:
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Can staff opt out of receiving
influenza vaccination
for MEDICAL reasons? |
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Please indicate which consequences apply
if the staff person refuses vaccination for
MEDICAL REASONS.
Check all that apply:
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Can staff opt out of receiving
influenza vaccination
for RELIGIOUS reasons? |
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Please indicate which consequences apply
if the staff person refuses vaccination for
RELIGIOUS REASONS.
Check all that apply:
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Can staff opt out of receiving
influenza vaccination
for reasons OTHER THAN MEDICAL OR RELIGIOUS? |
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Please indicate which consequences apply
if the staff person refuses vaccination for
OTHER REASONS.
Check all that apply:
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In your healthcare setting, what are the dates that
wearing a mask begins and ends, and how are
those dates determined?
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During a work shift, what
are the rules determining when
an unvaccinated staff member must wear a mask?
Check all that apply:
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Please tell us who is
covered by the mandate :
All healthcare personnel employed
in the facility |
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All healthcare
personnel who come into the
facility to see patients (e.g., all non-hospital-
based physicians) |
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All healthcare
personnel
with patient contact |
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Clerical staff |
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Janitorial staff |
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Laboratory staff |
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Dietary staff |
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Students |
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People who volunteer in
the facility |
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Approximately how many people are covered
by this mandate? (Enter integers only.)
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What is/was the implementation date?
(Provide precise MM/DD/YY if known.) |
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Please provide any additional information
about the mandate or any additional
comments you would like to share: |
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Please provide Internet links
to any
information about the mandate, such as
press releases or organization web page: |
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