COVID-19 Vaccinations will be mandatory for all healthcare workers from 15 October 2021 (or evidence of having been booked in for a first dose by 29 October 2021).

This form must be completed by all Western Health staff who:

- have booked for vaccination but yet to receive their first or second dose of the vaccine, or
- are planning on booking for vaccination but yet to receive their first or second dose of the vaccine, or
- have received the vaccination at a pharmacy, their General Practitioner, or a vaccination hub run by another health service, or
- are choosing to decline COVID-19 vaccination.

By completing this form you acknowledge that you are aware of the following:

  • A Public Health Order has made COVID vaccination mandatory for all healthcare workers in Victoria unless an individual has a valid medical exemption. The deadline for the first dose is 15 October 2021 and for second dose 15 December 2021.
  • COVID vaccination is recommended for me and all other healthcare workers to prevent COVID infection and its complications, including death.
  • If I become infected with COVID, I am infectious 48 hours before the symptoms appear and may spread the virus to patients, staff, family and others during this time period.
  • I cannot get COVID-19 from the COVID vaccine.
  • The consequences of my refusing to be vaccinated could endanger my health and the health of those with whom I have contact including patients in this healthcare setting, my co-workers, my family. It may also result in my not being able to continue in my role without a valid exemption.
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