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Employer Request for Onsite COVID-19 Vaccine Clinic

Employee Request Form for Onsite COVID-19 Vaccination Clinic

To register your company for an onsite vaccination clinic, please take the time to fill out all of the information below.

Business or School District
Point of Contact

The Erie County Health Department and Community Health Center will be accommodating Erie County businesses and local school districts by offering onsite vaccine clinics for their employees/students. Please review the site requirements below. If your agency is able to provide the requirements, please fill out the request form below. This request form is intended to be completed by company administration only.

Onsite Vaccination Clinic Requirements​​​

 

Employers and school districts must provide the following to be able to host an onsite vaccination clinic:

  • Indoor, accessible onsite space that is temperature controlled

  • Room to accommodate registration, vaccination, and post-vaccination observation

  • Tables and chairs

    • At minimum: Two 8-foot tables, 8 chairs, and chairs for post-vaccination observation​

Additionally, employers are responsible for:

  • Coordination of employees to vaccine clinic

  • Scheduling and assignment of employees within the vaccination clinic hours

  • Submission of required paperwork to the Erie County Health Department prior to the vaccination event

Students or employees ages 16-17 are only eligible to receive the Pfizer vaccine. Any youth under the age of 18 will need to be accompanied by a parent to their vaccine appointment for parental consent.

Alternative Vaccination Options​​​

 

If your place of business or school district is unable to meet the requirements needed to host an onsite vaccination clinic, alternative options are available! Your employees can receive their vaccine at:

  • Erie County Health Department / Erie County Community Health Center community vaccination clinics

    • Visit the Appointment Plus website to schedule your appointment date and time or​

    • Call ECHD/ECCHC to schedule an appointment at 419-626-5623 ext. 5174

  • Vaccine Providers in Erie County:

    • Firelands Regional Health System​

    • Family Health Services

    • Kroger

    • Walmart

    • Meijer

    • Rite Aid

    • Discount Drug Mart

    • Buderer Drug Co.

The Sandusky Transit System is offering free rides to vaccination locations throughout Erie County. You can plan your trip at www.SanduskyTransit.com by entering the address of the vaccine administration location in our Trip Planner tool. Sandusky Transit also offers door-to-door service if you do not live by a bus line. Call 419-627-0740 at least 48 hours in advance of your appointment to schedule a trip on Dial-A-Ride.

Onsite Vaccine Clinic Procedure​​

 

After the submission of this form, the following process will occur:

  • A representative from the Erie County Heath Department will contact your company's listed point person

  • ECHD will provide all forms that any employee wanting to receive the COVID-19 vaccine will need to complete prior to the scheduled vaccine event

  • Your company's point of contact will collect all forms from employees and submit them to ECHD

  • ECHD will contact the employer to schedule a date and time for the vaccination event