STAFF IMMUNIZATION RECORD

STAFF IMMUNIZATION RECORD
I have read the immunization guidelines
Date*

DayMonthYear
Date
Signature*

Clear
To the best of my knowledge my current immunization status is:

COMPLETE
Date of last Booster if known: Diphtheria/Tetanus Vaccination (if known):

DayMonthYear
Date
Date of last Flu Vaccination (if known):

DayMonthYear
Date
proof of vaccinations (please attach copy if available to be complete)

Cancelof
Incomplete (Unknown immunization status OR No written proof of vaccination)

INCOMPLETE
Employee encouraged to obtain recommended immunizations
Arcus Policy regarding accommodating employees who are not immunized or incompletely immunized was reviewed with this employee
Date*

DayMonthYear
Date
Staff Name printed*
Signature*

Clear
STAFF IMMUNIZATION RECORD

(UPON HIRE)
Arcus is required to obtain and keep a record of each employee's and volunteer's immunization status, even if the immunizations are incomplete. This information is required, as it will allow public health and medical staff to quickly identify each person's immunization status in the event of an outbreak.

TETANUS/DIPHTHERIA (Td):Recommended for all adults in Canada. A basic adult series (2 injections W months apart plus a booster 6-12 months after 2ⁿᵈ dose Booster doses of Td are recommended every 10 years, or at a minimum once during adult life. Provided free of charge by the Ministry of Health.

POLIOMYELATIS: A series of 3 IPV, (2 injections 2 months apart, 3ʳᵈ dose 12 months after 2ⁿᵈ dose) for persons who may have occupational contact with poliovirus. Provided free of charge by the Ministry of Health.

MEASLES (or MMR): For persons born between 1957 - 1970, proof of two live measles vaccinations, documentation of physician diagnosed measles or laboratory evidence of immunity. For person born prior to 1957, natural immunity is assumed. First dose provided free by the Ministry of Health.

RUBELLA (or MMR): One dose of live attenuated vaccine or serological test (ELISA) indicating immunity. The Rubella immune status of female employees of childbearing age should be carefully reviewed, and those without documented immunity should be vaccinated with MMR, unless there are contraindications. First dose provided free by the Ministry of Health.

HEPATITIS B: Recommended for HCW's who may be exposed to blood and/or body fluids, or who may be at an increased risk of sharps injury, bites or penetrating injuries. Not provided free by the Ministry of Health.

INFLUENZA: Annual influenza vaccine for staff has been shown to reduce the mortality and morbidity of residents in care facilities and to reduce worker illness during the influenza season. Provided free by the Ministry of Health for all workers who have contact with individuals in high risk

VARICELLA: Recommended for HCW's that do not have a reliable history of varicella disease or serologic evidence of immunity. Not provided free by the Ministry of Health.

COVID-19: Health care workers are required to report immune status for COVID-19 and other vaccine preventable diseases. Vaccination is considered complete when individuals have received the recommended number of doses for their age and health status.
Arcus Staff Immunization Policy
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