Columbia County Public Health
If you are a business in Columbia County and would like to request an onsite COVID Vaccine Clinic for your employees, please provide us with the following information:
Name of Business
Address where vaccine clinic would be hosted
Contact Name
Contact Phone Number
Contact Email
Please select your sector of work
Congregate housing
Construction, contractor, manufacturing
Farm/agriculture, food processing, food distribution
Transportation, retail, food service
Other
Is your business minority-owned?
Yes
No
How many employees do you have?
Approximately how many employees are interested in receiving the vaccine?
Approximately how many employees have health insurance?
Do any of your employees need services in a language other than English?
Yes
No
Would you consider any of the employees low-wage earners?
Yes
No
What type of vaccine clinic are you interested in?
Employee only
Employees and their families
Woud your worksite be willing to invite neighboring business to participate in your vaccine clinic?
Yes
No
Which vaccine is preferred by your employees
Moderna (will require 2 vaccine clinics, approximately 28 days apart)
Johnson & Johnson (one visit)
Pfizer - for those willing to host family members including those 12 years and older. (will require 2 vaccine clinics, approximately 21-28 days apart
No preference
Additional information or notes about your request:
Submit
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