COVID-19 Vaccine Informed Consent – Employee/Volunteer
This new form provides for informing the employee/volunteer about COVID-19 illness and is used to document consent or declination of the COVID-19 vaccine. It includes information regarding:
• Brief discussion of how the coronavirus is spread
• Clinical symptoms of COVID-19 illness
• Populations that should receive the COVID-19 vaccine
• Who should not receive or wait for the vaccine
• Clinical side effects of the vaccine
• 2 currently available vaccines: Pfizer-BioNTech and Moderna with hyperlinks to obtain the current Fact Sheets for each as part of obtaining informed consent [no VIS available as these vaccines are provided via EUA (Emergency Use Authorization) at this time]
• Option to sign for consent of the specific vaccine to be given, by the employee/volunteer
• Option to decline the vaccine, by the employee/volunteer
• Witness signature
Paper: White with black ink
Print: 2-sides different
Punching: 5-holes top and side
Packaging: 100 per pad