COVID-19 Vaccination Campaign – Manufacturing Safety Alliance of BC

COVID-19 immunization planning questionnaire

Company

Number of employees at your workplace:

Can you release staff during work hours to attend the clinic?

Yes No

Please provide the number of employees that require language assistance (best estimate is fine):

Mandarin

Cantonese

Punjabi

Tagalog

Korean

Farsi

Spanish

Other

Best clinic times for your employees:

Employees will have to book vaccination clinic appointments online. Do you anticipate any barriers with booking this way?

Yes No

Please provide your best estimate of the number of employees that would use each mode of transportation to get to a vaccination clinic:

Transit

Personal transport

Taxi

Shuttle

Carpool

Where do the majority of your employees live?

Does your site have an outdoor space that could be used for a vaccination clinic?

Yes No

If so, describe the layout, power requirements, square footage, and any other important details:

Can you provide crowd control to manage lineups?

Yes No

Lead contact name

Lead contact email

Lead contact phone

Alternate contact name

Alternate contact email

Alternate contact phone