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 

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