Vaccination Attestation Form Template

Do your policies require that your staff be vaccinated? You’ll need to have some procedure in place for checking and storing staff vaccination data. The WPForms’ Vaccination Attestation Form Template is ideal for this.

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Vaccinations help to keep your entire workforce safe, so if you do have any vaccination regulations in place, it’s important to enforce them effectively. This vaccination attestation form can help.

The form begins with the basic Name, Email, and Address fields. Next, there is a single-line text field asking for the brand of vaccine the user has taken. This is important because there are several brands available for most vaccines, and each one is administered differently and may require a different number of shots.

The next field is a dropdown that follows up by asking how many shots are required for the vaccine the user took. The options range from 1 – 3, and each triggers the display of specific additional fields.

If the user chooses 1, the form will display a single-line text field asking for the date of their most recent vaccination. If the user selects 2, this field will change to display a two-column Layout field, asking for the dates when the two shots were taken. Similarly, if the user chooses 3, a 3-column Layout field will appear, asking for the dates of the previous three shots.

The template also includes a Paragraph Text field for other relevant details, along with a Signature field and a File Upload Field for uploading their vaccination certificate and any other supporting documents.

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