Fully Vaccinated Employee Survey
Please complete this form when you have received the final dose (2nd if 2 needed; 1st if 1 needed) of the COVID-19 Vaccine
* Required
Email address
*
Your email
Last Name
*
Your answer
First Name
*
Your answer
What is your role at school?
*
Administrative Staff
Clerical/Support Staff
Custodial/Grounds Staff
Food Service Staff
Security Staff
Teacher
Teacher Aide
Teaching Assistant
Technology Staff
Transportation Staff
Other:
At which location do you primarily work?
*
Elementary School
Intermediate School
High School
Bus Garage
District Office
I received the final dose of my vaccine on this date. Two doses are needed for Pfizer and Moderna. It is expected that Johnson & Johnson, when approved, will need 1 shot.
*
MM
/
DD
/
YYYY
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