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APPENDIX A Sample COVID-19 Vaccination Policy

APPENDIX A – Sample COVID-19 Vaccination Policy [POLICY TITLE] (e.g., COVID-19 VACCINATION POLICY) PURPOSE To ensure that [Organization’s Name] employees are adequately immunized to minimize their risk of infection and to reduce the risk of transmission to others. POLICY STATEMENT

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14. No Smoking Policy (Sample) POLICY

www.healthunit.com

Smoking is prohibited at all times, with the exception of during specified breaks, at which time the employee must smoke in designated outdoor areas. 4. No Smoking signs must be posted at all entrances and exits, washrooms, and in workplace vehicles. 5. If an employee does not comply with this policy, the issue will be dealt

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6. Infection Control Policy (Sample) Infection Control

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and use routine infection control precautions and; 2) are aware of recommended immunizations for adults that help to prevent the transmission of infections amongst employees. POLICY: All staff will adhere to routine infection control precautions and will keep immunization status up to date in accordance with Ministry of Health

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APPENDIX C Sample COVID-19 Vaccination Medical …

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APPENDIX C – Sample COVID-19 Vaccination Medical Exemption Form MEDICAL EXEMPTION TO DECLINE THE COVID-19 VACCINE _____ has a medical exemption for the COVID-19 Vaccine in Printed Name of Employee relation to a condition indicated below. The following conditions are the only absolute medical exemptions from the COVID-19 vaccine: ...

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COVID-19 Vaccination Clinic Demographic Form

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HEALTH CARE PROVIDER INFLUENZA VACCINE CONSENT …

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I consent to receiving the seasonal influenza vaccine. If signing for someone other than yourself, indicate your relationship to that other person: _____ If signing for someone other than myself, I confirm that I am the parent / legal guardian or substitute decision maker.

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