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COVID-19 Vaccine Survey
This survey is to determine vaccination needs at your facility. Using these numbers, KCHD will be able to ensure there is enough allocated for each request and ensure no wastage of the vaccine. If you have any questions, please contact Ishani Doshi:
idoshi@co.kendall.il.us
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Date
Your answer
Facility Type
Physician's Office
Home Hospice
Fire Department
Police Department
Education
Food and Agriculture
Utlities
Corrections
Transportation
Other:
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Facility Name
Your answer
Name of Point of Contact
Your answer
Phone Number
Your answer
How many employees at your Kendall County facility?
Your answer
How many employees are interested in the vaccine?
Your answer
Are you a provider site (pending registration into I-CARE) or will KCHD be vaccinating onsite?
Provider Site
KCHD Run Vaccinations
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If you're a provider, have you been approved by the CDC to administer vaccinations?
Yes
No
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Availability
Morning - 9AM to 12PM
Afternoon 1PM - 3PM
Evening
Monday
Tuesday
Wednesday
Thursday
Friday
Morning - 9AM to 12PM
Afternoon 1PM - 3PM
Evening
Monday
Tuesday
Wednesday
Thursday
Friday
Describe the physical location where the site would be held (Carport, Medical Bay, Loading Dock area, etc...)
Your answer
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