Please choose the new employee forms for your state below:
In order to promote and maintain a safe and healthy environment for our employees, patients, and visitors, the following vaccinations or proof of immunity, are required prior to beginning work:
• Hepatitis B Vaccines x 3, Titer showing immunity, or Declination statement
• QuantiFERON titer
• MMR Vaccines x 2 or Titer showing immunity to: Rubeola, Mumps, and Rubella
• Varicella Vaccines x 2 or Titer showing immunity
• Influenza Vaccine if hired September – March.
• Tdap Booster, recommended every 10 years
• COVID-19 Vaccine, strongly recommended
(2-doses for Moderna & Pfizer, 1-dose for Johnson & Johnson)
To save time and a needle stick, please complete the HIPAA-compliant release of immunization information form. Save a copy to your computer and attach the completed forms in an email to email@example.com.
If records cannot be obtained, PIC will provide you with either titers or
vaccinations depending on employee needs.
If you have any questions, please contact Employee Health at firstname.lastname@example.org. We
look forward to working with you.
Employee Health Team