MAKE YOUR FREE Proof of Vaccination
What is a Proof of Vaccination?
Sample Proof of Vaccination
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Personal Information
Address:
,
Email:
Phone:
Please check the vaccine(s) that received:
I, received the vaccine(s) listed above and that all information on this form is correct and true.
| ___________________________________ | __________________ |
| Date |
Proof of Vaccination FAQs
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Can businesses require proof of vaccination?
In general, yes. Businesses may request proof of vaccination from employees and from customers to keep their staff and communities-at-large safe. The Equal Employment Opportunity Commission (EEOC) has stated that COVID-19 vaccination mandates are allowed, as long as employers don't violate federal guidelines that protect against discrimination. For example, under the Americans with Disabilities Act (ADA) and Title VII of the Civil Rights Act, reasonable accommodations must be provided for employees who have a disability or sincerely held religious belief that prevents them from being vaccinated. Such exemptions should be documented in a Vaccine Exemption form signed by the employee. In general, it is also a good idea to document your overall Vaccination Policy and have it reviewed by an attorney .
Several states, including Texas, Florida, and Montana, have imposed some limitations around vaccine verification, policy enforcement, and incentives, so it is in your best interest to talk to a local attorney to see if there are additional restrictions that may apply to your business.
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What vaccines does this verification form cover?
This Proof of Vaccination form enables you to request verification of a number of common vaccines. When building your document, you may select which vaccines to include and customize the form to include any others. Here is the full list of vaccine options, organized in alphabetical order:
- Adenovirus
- Anthrax
- Cholera
- Coronavirus (COVID-19)
- Haemophilus Influenzae Type b (Hib)
- Hepatitis A
- Hepatitis B
- Human Papillomavirus (HPV)
- Influenza (Flu)
- Japanese Encephalitis (JE)
- Measles, Mumps, Rubella (MMR)
- Meningococcal
- Poliomyelitis (Polio)
- Rabies
- Rotavirus
- Shingles
- Smallpox
- Tetanus, Diphtheria, Pertussis (Tdap)
- Tuberculosis
- Typhoid Fever
- Varicella (Chicken Pox)
- Yellow Fever
For the COVID-19 vaccine specifically, you also have the option of requesting information about the manufacturer of the vaccine and the date(s) it was received.
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How can my employees sign this Proof of Vaccination form online?
As a Rocket Lawyer Premium member, you can make and send out as many copies as you need to. Once you have drafted the first copy of your Proof of Vaccination template, you will have the ability to interact with it in a number of ways. You can change your answers or use our advanced editing tool to customize the language exactly to your needs. Once you are satisfied with the document, you have the option to download it (or print it, if desired.)
In order to gather electronic signatures online using RocketSign®, you will want to follow these instructions:
- Download the document in PDF format.
- Upload the PDF to your account. (You will need to be logged in.)
- Follow the instructions on screen to tag your document with signature, date, and text fields to fill in the blanks.
- When prompted to select the signer, you will have the opportunity to add the name and email address of the target recipient.
- When you place the date field, be sure that the signer is the person selected.
- When you place the text fields, be sure to mark which fields are required. Don't forget to add text fields next to each required vaccine.
- If you are satisfied, invite your first signer by selecting "Next step", followed by "Invite to Sign."
- You will have the opportunity to create a special name for your document, such as, "Employee Proof of Vaccination". It may also help to add your company name here to provide more context to the recipient.
- You also have the option of adding a customized message to the signer. If you plan to send this vaccine confirmation form to multiple recipients, be sure to copy and paste your message somewhere safe for future reference.
- You will receive an email confirmation that the form has been sent, viewed, and signed. You also have the ability to cancel your request or send reminders.
- If you are sending to multiple people, you can make a copy of your uploaded document and change the signer information in order to send to another individual.
If you have any technical questions, feel free to contact customer support for further assistance.
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Is asking for proof of vaccination a HIPAA violation?
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that protects patient health information from being disclosed without permission. HIPAA generally applies to healthcare providers and insurance companies, so most private businesses and employers are not subject to HIPAA as it relates to requesting or receiving information about an individual's vaccination status.
