Skip to main content Accessibility statement

BMS Staff Vaccination Survey (Chicago)

Please complete the following questions regarding your COVID-19 vaccination status:

Name *
First
Last
Work location: *
What is the best phone number to reach you, if necessary? *
Email
Are you fully vaccinated against COVID-19? *
Yes, fully vaccinated
Partially vaccinated
No
No, but I plan to get vaccinated
When do you plan to get vaccinated?
Upload a copy of your COVID-19 vaccination record, if FULLY vaccinated:

Drag & Drop Files, Choose Files to Upload

It may take up to a minute to upload the file. You may also provide a copy of your vaccination record to your manager, or email it to aosmanovic@bmsllc.com.