COVID-19 Vaccine-Phase 1b

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During Phase 1b, COVID19 vaccines will come in waves and knowing the estimated number of individuals in Phase 1b interested in receiving the vaccine will assist in planning, distributing, and administering the vaccine to those eligible. This survey is also in place to determine appropriate points of contact to provide vaccine schedule information.

The Phase 1b is only eligible for those who meet the definition of frontline workers, those in the field with public contact. A survey will follow for all other essential workers as they fall into Phase 1c.

Employer Name *

Address for organization *

Name of primary organization point of contact *

Email address for primary organization point of contact *

Phone number for primary organization point of contact *

Phase 1b are those who are identified as frontline workers (those in the field with public contact). Please identify your Phase 1b category : *

Emergency Services (Non-medical first responders, law enforcement, fire fighters, child and youth services, shelters, non-residential social services, durable goods merchants including safety devices, justice and safety activities,)

Teachers/Daycares (Child Care Workers – formal and informal, Preschools, Elementary and Secondary School Personnel, Community Colleges, Colleges and Universities, Trade Schools)

Agriculture Workers/ Food Service/ Grocery (Agricultural Workers, Animal/Seafood/Bakeries Food Manufacturing and Slaughtering/Processing, Fruit, Vegetable, Dairy and Special Foods Manufacturing, Grocery Stores/Food Markets, Food and Drinking Establishments, Pharmacies/Drug Stores, Warehouse Clubs, Community Food Services, Nurseries/Florists)

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