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GMSC Staff Vaccination Survey

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 applicable:

Click or drag a file to this area 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.