Trinity REQUIRES ALL employees, medical staff, contract employees, volunteers and students affiliated with the Health System to receive their flu vaccination. Participation is mandatory and must be completed by Nov. 15th. Please find a date that works for you.
*******PLEASE POST IN YOUR DEPT. MORE FLU SHOT OPPORTUNITIES********
EAST CAMPUS: Mon.-Fri. 8a-4p at WorkCare Clinic
Every Wed. 7a-930a, on 4th floor
Thursday, Oct. 17th:
7a OR/PACU Corridor
730a 3rd Floor by 3 bank elevators
830a Teramana Cancer Center
9a Arena-Sports Med.
Fri., Oct. 18th:
Fri., Oct. 25th: Starting on 7th floor at 6am and working down floor to floor to capture night shift and daylight until 9a.
Important Dates to remember this flu vaccination season!
SEPT. 30TH MANDATORY CHI KNOWLEDGE HUB EDUCATION MUST BE COMPLETED.
APPENDIX A FORM EXEMPTION REQUEST MUST BE SUBMITTED FOR APPROVAL. SEE BELOW:
APPENDIX A TRINITY INFLUENZA VACCINATION EXEMPTION REQUEST FORM Name:______________________________________ Employee ID:_______________________ Trinity Health System is committed to improving and protecting the health and well-being of its patients, visitors, volunteers, physicians and employees. This applies to employees, physicians, volunteers, contracted personnel, students, non-employed medical staff, and vendor’s representatives who work in all Trinity facilities unless otherwise exempted due to medical or religious contraindications. I am requesting exemption for one of the following: ____ Medical (Complete Part I) _____ Religious (Complete Part II) Part I-Please indicate applicable medical contraindications to the influenza vaccine: ____ Previous severe reaction to influenza vaccine (e.g., hives, difficulty breathing, swelling of tongue or lips) NOTE: The above does not include sensitivity to the vaccine such as mild to moderate local reactions, soreness, redness, itching or swelling at the injection site, and/or slight ill feeling including upper respiratory infection or low-grade or moderate fever following a prior dose of the vaccine. ____ History of Guillain-Barre’ Syndrome (GBS) ____ Other-(please describe reaction/contraindication): Note: A severe egg allergy will not be accepted as a medical exemption as the vaccine is an egg-free vaccine. Part II-Please indicate applicable religious organization where influenza vaccination is contraindicated according to my doctrine or religious practices. I understand that my religious organization may be contacted for further clarification. Religious organization:___________________________________________________________ I certify that the above exemptions apply to my ability to receive an influenza vaccination. Trinity reserves the right to substantiate any of the above exemptions/contraindications and I agree to comply if requested with any additional supporting documentation requests. I fully understand that any misrepresentation will result in positive discipline up to and including discharge. I also understand that, if exemption is approved, I must wear surgical mask at all times while in a patient care area and within 6 feet of a patient, visitor or co-worker during influenza season. Signature________________________________________________Date:_________________ Submit completed form to Employee Health Fax: 740-264-0148
NOV. 15TH ALL STAFF MUST BE VACCINATED OR HAVE RECEIVED THEIR APPROVED EXEMPTION (APPENDIX A).
WHAT IS CONSIDERED A SEVERE REACTION TO THE FLU VACCINE?
Previous severe reaction to influenza vaccine (e.g., hives, difficulty breathing, swelling of tongue or lips)
Note: The above does not include sensitivity to the vaccine such as mild to moderate local reactions, soreness, redness, itching or swelling at the injection site, and/or slight ill feeling including upper respiratory infection or low-grade or moderate fever following a prior dose of the vaccine.
*** A SEVERE EGG ALLERGY WILL NOT BE ACCEPTED AS A MEDICAL EXEMPTION AS THE VACCINE IS AN EGG-FREE VACCINE.