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Re-engaging with the Mass Vaccination programme
Please complete this before we reach out to you
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1
Name
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First Name
Last Name
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2
Date of birth
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Date
Day
Month
Year
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3
Phone Number
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Please give your number so we can call you to discuss this further
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4
Have you completed a shift for the Mass Vacc programme at all? Please state yes or no. If yes, when was this?
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5
If you are willing to re-engage, what locations are you willing to travel to? (Options are: UWE, Outreach settings, Bristol Inner City (Cabot Circus), PCN settings across Bristol).
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6
What has stopped you from picking up a shift for the Mass Vacc programme in recent months?
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Sickness
Change in address
Change in work life
Change in personal circumstances
Didn't enjoy my shifts
Management on site
Lack of training
Lack of shifts
Prefer not to say
Other
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7
If you are willing to re-engage, how soon could you work a shift and how many hours per week could you offer? (please state)
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