Vaccination Volunteers Induction Quiz

Name *

First Name

Last Name

Risk Assessment *

Please tick to confirm which of the following are true:

I am fit and well enough to be able to complete the duties of a 4 hour shift that may include standing outside for a long period (with breaks)

I am currently fit and well with no symptoms of Coronavirus? (It is important that you notify us if your Covid status changes at anytime, either through developing symptoms or you are advised to isolate by Test and Trace)

You may contact me at short notice to volunteer (this is not required)

I certify that I carried out the Covid Age Risk Assessment honestly and accurately.

I certify that if I had doubts about the accuracy of my responses, or, I am taking immumosuppressant medication, or I have any concerns about my health in relation to COVID-19 risks, I have taken further advice from my GP.

I confirm I will notify WERN immediately if I should become aware of anything that may change my COVID-19 risk level.

I give permission for WERN to hold my COVID-19 Risk Category on their IT System and share it with clinical staff responsible for volunteer management at the Vaccine centre.

ID

Please tick if you have already uploaded a scanned copy of 2 of the following documents to your profile ID and Qualifications tab:

i) Passport

ii) Photo Driving Licence

iii) Current utility bill or similar with your address (within 3 months)

DBS Expiry Date:

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