Addus Vax Tracker V2

Thanks for visiting the Addus Vax Tracker. Addus Homecare will be using this system to collect vaccination statuses and completed vaccine cards from our employees. Please fill out all of the sections below. Thank you in advance for your efforts to fight COVID-19!

Please enter employee's first and last name *

First Name Last Name

Are you filling this out for another employee? *

Please enter your first and last name

First Name Last Name

What is the best phone number to reach you?

Please enter a valid phone number.

What is the employee's primary branch?

Is this for a new employee? *

What is the employee's phone number? *

Employee's birth month and day?(MM/DD)

Are you submitting a booster shot? *

Have you been fully vaccinated or received your first dose? (Pfizer and Moderna = 2 Doses, AstraZeneca/Johnson and Johnson = 1 Dose) *

When are you scheduled to receive your first shot?

Date

When are you scheduled to receive your second shot?

Date

Please Take a Picture of your Vaccination Record Card and Click Below to Upload the Picture. Please ensure it's easy to read. *

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Addus HomeCare Vax Tracker