Workforce COVID-19 vaccine planning form (Phases 1B and 1C)
This form is intended for Philadelphia-based organizations/companies that are employers of workers who are included in Phase 1B or Phase 1C of the City of Philadelphia's schedule of priority populations for COVID-19 vaccine. Employers should attest that their workforce meets the prioritization criteria, as laid out in the schedule of priority populations. A single representative from your business or organization should complete the form and attest to the eligibility of your workforce.
Please fill out this questionnaire, which will inform the Health Department's plans for distributing vaccine to workers in Phase 1B and Phase 1C. By filling out the form on behalf of your organization, you are signing up interested members of your workforce to receive COVID-19 vaccine when available. Depending on vaccine availability, there may be sub-prioritization within each of the phases.
Registering on this website signals your interest to the Health Department that you would like to coordinate with us to vaccinate your employees. Due to the extremely limited number of doses available, it may be weeks to months before the Health Department is able to reach out to begin planning with you.
If you have further questions about COVID-19 vaccine, visit the Health Department's FAQ page.