Communicable Disease Control Branch ~ Immunisation Section

Model Documents: HCW Annual Influenza Vaccination Program

Download Adobe PDF Reader

It is the responsibility of health care organisations to support high standards of infection control practice as a first line of protection for staff against communicable diseases in addition to a robust immunisation policy.

Maintaining immunity in the HCW population helps prevent transmission of vaccine-preventable diseases to and from health care workers and patients through a coordinated immunisation program.

Model Documents

This resource has been developed by the Communicable Disease Control Branch, SA Health and is recommended to support those responsible for the provision of the Health Care Worker Influenza Vaccination Program.

• Model Documents: HCW Annual Influenza Vaccination Program (PDF 253KB)

Attachments

Section C Attachments are also provided below as Word documents:

• Attachment 1 - Example Immunisation Policy Document

• Attachment 2 - Risks and Benefits table

• Attachment 3 - Pre-vaccination checklist

• Attachment 4 - Pre-Vaccination Assessment table

• Attachment 5 - Employee Consent Form – Influenza Vaccine

• Attachment 6 - Employee Influenza Vaccine Declination Form

• Attachment 7 - Relevant Influenza websites

• Attachment 8 - Sample Template – Timetable of Clinics

• Attachment 9 - Reminder Memo Template

• Attachment 10 - Sample Template – Daily Running Sheet

• Attachment 11 - Sample template – Post Influenza Vaccination Program Employee Survey

Ordering vaccines

To order more influenza vaccines, please complete the Vaccine order form (PDF 77KB)

Immunisation Section ~ Telephone 1300 232 272 ~ Fax 8226 7197

Contact Us | Home | Communicable Diseases Index | Immunisation Index | You've Got What? | Environmental Health Index | Food Safety Index | Health Promotion | SA Cervix Screening Program