COVID-19 Vaccination Policy: Self-Attestation Form
The Vector Institute is committed to providing a safe working environment for our professional staff and research community, and has implemented a COVID-19 Vaccination Policy (the “Policy”) (https://vectorinstitute.ai/wp-content/uploads/2021/09/covid-19-vaccination-policy-september-16-online.pdf) to set out the expectations and requirements with respect to COVID-19 vaccinations of all community members and visitors accessing the Vector Institute’s offices.

Under the Policy, all Individuals and Visitors (as defined therein) must declare in a self-attestation that they are fully vaccinated in order to be permitted entry into the Vector Institute’s offices.

You are required to provide accurate information in this self-attestation. Information collected pursuant to this self-attestation will be kept in a secure, confidential file, accessible only to those few individuals who have a need to review it.

This information is collected for the purpose of implementing the Policy and ensuring the safety of Vector’s community members in the event of a COVID-19 outbreak.

All information collected as part of this Self-Attestation From is being done in accordance with Vector’s Employee Privacy and Confidentiality Policy (https://vectorinstitute.ai/wp-content/uploads/2019/12/employee-privacy-and-confidentiality-policy.pdf) as well as Vector’s External Privacy Policy (https://vectorinstitute.ai/wp-content/uploads/2019/12/external-privacy-policy.pdf).

You may decline to provide your vaccination status. If you decline to provide information about your vaccination status, we will assume you are unvaccinated for the purposes of the Policy.

If you have any questions, please contact Vector's Human Resources team at hr@vectorinstitute.ai.
Sign in to Google to save your progress. Learn more
Email *
First Name *
Last Name *
Vaccination Status
Health Canada updates its list of approved vaccinations, at a link found here: https://www.canada.ca/en/health-canada/services/drugs-health-products/covid19-industry/drugs-vaccines-treatments/vaccines.html

People are generally considered “fully vaccinated” 14 days after completing:
(i)  the full series of a COVID-19 vaccine authorized by Health Canada, or any combination of such vaccines;

(ii)  one or two doses of a COVID-19 vaccine not authorized by Health Canada, followed by one dose of a COVID-19 mRNA vaccine authorized by Health Canada; or

(iii)  three doses of a COVID-19 vaccine not authorized by Health Canada.

Generally, “partially vaccinated or partially protected” means you have received only one dose of a two-dose COVID-19 vaccine, or you are completing this form within two weeks after receiving a final dose.
Declaration and Attestation *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Vector Institute. Report Abuse