Mandatory Vaccine Survey

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The District is making early preparations to offer the Coronavirus (COVID) Vaccine to active employees. This mandatory survey will provide information to help with the preparation.

Survey responses are due before Monday, February 1, 2021.

First and Last Name *

What department do you work in at the District? *

Engineering

Executive Director

Finance

Human Resources

Information Technology

Legal

Operations

Secretary Treasurer

Do you want to receive the COVID Vaccine at work? *

Yes

If you have concerns about receiving the COVID Vaccine, which response best defines your reason?

I don’t have concerns about the COVID Vaccine.

I have concerns about the vaccine side effects, long-term safety and efficacy.

I do not believe it will be a solution for the Coronavirus disease.

I believe that it will have negative effects on my health.

I do not want to disclose this information.

Clear selection

What additional information could ease possible concerns about getting the COVID Vaccine?

If my doctor would approve.

If a detailed written review would be shared with the public about how the vaccine was produced and what it contains.

I want to wait for a period to observe how other people react to the vaccine.

I do not want to disclose this information.

Clear selection

Submit

Clear form

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