COVID-19 vaccination

Name *

First Name Last Name

Home/location

Which of these best outlines your situation? *

I have had one or both of my vaccinations I have not yet had a vaccine, but will do before the deadline I am exempt from having the vaccine I am NOT exempt from having the vaccine, but choose not to be vaccinated

If you have had the vaccine, you can demonstrate this using the NHS COVID Pass service via the following routes:

1. The NHS App (please select TRAVEL)

2. The NHS COVID Pass letter (request online or via 119)

Your COVID-PASS will need to show the dates you received your vaccination; for this reason, please do NOT use the domestic option (as this only shows a 'tick', which is also granted for anyone who has a recently had a negative LFD test). Please instead use the TRAVEL option.

Please be aware that an appointment card cannot be used as proof of vaccination status.

Please upload evidence of your COVID-19 Pass *

I have had *

My first vaccine only Both vaccinations

Before April 2022, you will need to be able to evidence either a full vaccination status or exemption.

We are waiting for guidance to be released about how staff can evidence they are exempt from the vaccination. The current information indicates that there will only be a small minority of individuals who are medically exempt. It seems that religious grounds, pregnancy, and breast feeding will not be reasons for exemption (and the legislation will still apply).

By the end of March 2022, you will need to be able to evidence either a full vaccination status or exemption. For this reason, if you are unsure whether or not you are exempt, you may wish to discuss this with your GP and have a plan in place for both eventualities.

Please be aware that (unless you are exempt) you will need to have your first vaccine by the latest 3rd of February 2022, otherwise it will not be possible for you to meet the final deadline (allowing for the 8 week waiting period between vaccinations). Please provide evidence once you have received your first and second vaccination.

NOTE: If you are requesting evidence through 119, you will need to also allow 5 days (processing) and 1 week (postal) for your evidence to arrive. This means you would need to have received your first vaccination by around the 21st of January 2022.

Space for anything further you would wish to say, or anything you feel we need to know