Phase 1: El Dorado County COVID Vaccine Assessment for Partners and Providers

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Please discuss the following questions the vaccination planning team at your agency. Survey responses will be used to by a multi-agency coordination group to equitably allocate COVID-19 vaccine in El Dorado County.

(Complete only one response per agency)

Facility/Entity Name *

Which sector best describes your facility or entity? *

Acute Health Care Provider

Psychiatric Hospital

Skilled Nursing Facility

Assisted Living Facility

Long Term Care/Residential Care Facility

Paramedic/EMT Service Provider

Dialysis Center

Intermediate Care Facility

Home Health Care Provider

Community Health Workers

Public Health Field Staff

Primary Care Clinic, Rural Health Clinic, Correctional Facility Clinical Staff

Specialty Clinic

Laboratory Staff

Dental/Oral Health Clinic

Pharmacy Staff (in a setting other than listed above)

Other:

Have you registered your facility on the COVID Readi website? *

Any agency that intends to administer the vaccine needs to register. Go to: https://ca.covidreadi.com When the Redistribution Agreement is made available providers will also need to compete an agreement with Public Heath prior to distribution.

Yes

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