Employee COVID Vaccination Survey – The Gathering Spot

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Employee COVID-19 Vaccination Survey

The Gathering Spot is requesting input from employees regarding their COVID-19 vaccination status, as we continue our vigilance in light of the COVID-19 pandemic.

Employee Name(Required)

Department(Required)

TGS Location(Required)

Have you received the COVID-19 Vaccine?(Required)

Yes

No

If no, do you plan to take the COVID-19 Vaccine?(Required)

Yes

No

Hidden

If you are planning on receiving the vaccine, in what time frame do you plan to do so?

Within the next month

Within the next three months

Within the next six months

Other

Hidden

If you are planning on receiving the vaccine, where would you prefer to receive it if given the choice:

My healthcare provider

Local health department

Vaccination Clinic at The Gathering Spot worksite

Other

Hidden

If you do not plan on receiving the vaccine, do you have a medical reason for not receiving the COVID-19 vaccine?

Yes

No

Hidden

If you do not plan on receiving the vaccine, do you have a religious objection to receiving the COVID-19 Vaccine?

Yes

No

Proof of Vaccination

Max. file size: 4 GB.

TGS

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The Gathering Spot HQ
384 Northyards Blvd NW
Building 100, Suite 190
Atlanta, GA 30313