COVID-19 Vaccination - Worksite Survey and Enrollment

CRITICAL WORKFORCE - WORKSITE SURVEY

If your organization/worksite is identified as having personnel that could potentially be offered early COVID-19 vaccine due to the nature of their work and the critical role they play in societal function, please complete this survey: https://forms.gle/YcfSD285vVskwhGM8

Note: if having difficulty accessing the survey form, try accessing via a different browser.

CDC COVID-19 VACCINE PROGRAM - PROVIDER ENROLLMENT ("PROVIDER AGREEMENT")

In order to receive COVID-19 vaccine for eventual administration to patients, sites must first enroll in the CDC COVID-19 Vaccine Program. It is best that you do this now before vaccines begin to become available to the state of Louisiana.

To complete the COVID-19 Vaccine Program provider enrollment ("Provider Agreement"), click here. Note: If your organization does not plan on being a vaccine administrator (example: only critical workforce staff at your site need vaccination), your organization does not need to complete this form.

Resources are available to assist sites in the enrollment process including a Frequently Asked Questions document and a Common Mistakes document.

SUPPLEMENTAL REDISTRIBUTION AGREEMENT (OPTIONAL)

Some organizations may be planning to redistribute vaccines to additional sites within their organizational system. These organizations can access the vaccine redistribution agreement by clicking here.

ACCESSING FORMS

All of these forms and resources can also be accessed by going to the Documents Center within the LINKS website at https://lalinks.org/linksweb/LINKS_DCNTR.html

ADDITIONAL ASSISTANCE

Send questions involving the worksite survey to la.immunization@la.gov

Send questions involving the CDC COVID-19 Vaccine Program enrollment process to la.links@la.gov