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Employee Vaccination Form

Hendra Holiday Park

Please complete the form below and click submit.
Should we need to contact you your line manager will be in contact.

Employee Details
Name*
First Last
COVID-19 Questionnaire
Have you had your first Covid-19 vaccination?*
- Yes
- No
If Yes, what date was your first vaccination?
DD dash MM dash YYYY
Have you had your second Covid-19 vaccination?*
- Yes
- No
If Yes, what date was your second vaccination?
DD dash MM dash YYYY
Have you got a date for your first or second vaccination booked*
- First
- Second
- First & Second
- Already had both
If you have your first vaccination booked plese let us know the date.
DD dash MM dash YYYY
If you have your second vaccination booked plese let us know the date.
DD dash MM dash YYYY
Please indicate if you currently intend to abstain from having the Covid-19 vaccinations.
- I currently intend to abstain
We are only asking this question to ensure we that we can provide you with a safe working environment.

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