Rufus Covid vaccination site workforce data collection

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Thank you for taking the time to fill in this survey. In doing so, you will not be scheduled in for any activity without being contacted to confirm your availability. In anticipation of your support, we are very grateful for your contribution.

Our privacy policy can be found at www.rufusvaccinehub.co.uk

The Rufus Centre
Steppingley Road,
Flitwick,
Beds MK45 1AH

rufusvaccinehub@gmail.com

Question Title

* 1. Contact details

Name *

Company

Address *

Address 2

City/Town *

State/Province

ZIP/Postal Code *

Email Address *

Phone Number *

Question Title

* 2. What is your profession

Nurse

Doctor

Pharmacist

Medical other

Non medical support staff

Question Title

* 3. which of these tasks are you looking to carry out?

If offering to vaccinate, you will need to have been providing vaccinations in some capacity in the previous 12 months.
Online training for Covid vaccination must be verified as completed before first shift.

Training for Covid vaccine reconstitution and preparation will be provided on the day

Vaccinating patients

Preparing vaccines

Data entry/record keeping

Steward

Other (please specify)

Question Title

* 4. Are you filling out this survey as a volunteer?

Yes, I am a volunteer

No, I am looking for paid work only

I am looking to be paid, but I am also willing to donate some time to help

Question Title

* 5. From what date will you be available to support the service?

Date / Time

Date