Staff Member Vaccination Status Survey
Please submit updates for the School Nurses regarding your vaccination status using this form
Your Full Name
If you are a multi-building staff member, please select the building where you spend the majority of your time
BUFFALO ELEMENTARY SCHOOL
SOUTH BUFFALO ELEMENTARY SCHOOL
NONE - ATHLETICS OR EXTRACURRICULARS
Have you elected to receive the COVID-19 vaccine and if so which one?
Yes, I have received the Johnson & Johnson (J&J) vaccine
Yes, I have received the Moderna vaccine
Yes, I have received the Pfizer vaccine
No, I have elected not to be vaccinated against COVID-19
When did/are you to receive your FINAL dose of the Moderna or Pfizer vaccine or the first dose of the J&J vaccine?
Never submit passwords through Google Forms.
This form was created inside of Freeport.k12.pa.us.