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Vaccination recording form

If you have had your winter vaccination (COVID-19 booster or flu vaccination, or both) outside of the Trust, for example via your GP surgery or pharmacist, you can let us know using this form so that we can update our records.

Please do not use this form if you received your vaccination(s) at work (from Occupational Health, at a drop-in session or within your ward/department).

Division*
Staff group*
Gender*
Ethnicity*
Which vaccination(s) did you receive? (please tick all that apply)*