Form

COVID-19 vaccination: consent form and letter for social care staff

Coronavirus (COVID-19) vaccination consent forms and letter templates for use by GPs, the NHS or healthcare and social care employer organisations.

• From: Public Health England
• Published: 7 December 2020
• Last updated: 26 January 2021 — See all updates

Documents

COVID-19 vaccination consent form for frontline social care workers (open source version)

Ref: PHE gateway number 2020408

ODT, 29.3 KB

This file is in an OpenDocument format

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COVID-19 vaccination consent form for frontline social care workers (MS Word version)

Ref: 2020408

MS Word Document, 144 KB

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COVID-19 vaccination consent form for frontline social care workers (PDF version)

Ref: PHE gateway number 2020408

PDF, 51.7 KB, 1 page

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COVID-19 vaccination consent form letter for frontline social care staff (open source version)

Ref: PHE gateway number 2020416

ODT, 72.9 KB

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COVID-19 vaccination consent form letter for frontline social care staff (MS Word version)

Ref: PHE gateway number 2020416

MS Word Document, 81.8 KB

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If you use assistive technology (such as a screen reader) and need a version of this document in a more accessible format, please email [email protected]. Please tell us what format you need. It will help us if you say what assistive technology you use.

COVID-19 vaccination consent form for social care workers (open source version)

ODT, 26.5 KB

This file is in an OpenDocument format

This file may not be suitable for users of assistive technology.

Request an accessible format.

If you use assistive technology (such as a screen reader) and need a version of this document in a more accessible format, please email [email protected]. Please tell us what format you need. It will help us if you say what assistive technology you use.

COVID-19 vaccination consent form for social care workers (MS Word version)

MS Word Document, 137 KB

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If you use assistive technology (such as a screen reader) and need a version of this document in a more accessible format, please email [email protected]. Please tell us what format you need. It will help us if you say what assistive technology you use.

COVID-19 vaccination consent form for social care workers (PDF version)

Ref: PHE gateway number 2020370

PDF, 51.2 KB, 1 page

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COVID-19 vaccination consent form letter for social care staff (open source version)

ODT, 22.3 KB

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COVID-19 vaccination consent form letter for social care staff (MS Word version)

MS Word Document, 35.4 KB

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Details

The consent form is only for use by clinical staff administering vaccinations and there is no requirement for written consent to access a vaccination. However, you can take the consent form to your vaccination appointment to save time as you may be asked to complete it there.

Please do not send your consent form to any third party. They are not authorised to process personal information and will need to destroy any consent forms containing personal data along with any related communication.

If you are seeking help about how to get a vaccination appointment, please get in touch with your employer in the first instance. Employers are responsible for facilitating and actively supporting access to vaccination. These may be as part of block booking arrangements they have made for their staff or by giving you information about how you make your own appointment.

If you are an agency worker the agency is your employer.

If you are a self-employed social care worker you should contact the Adult Social Care lead for your Local Authority.

Further information on who is eligible for a vaccination at the moment is available.

Local NHS and local councils are working together to make sure you are contacted so please do not contact your local GP or hospital.

Paper copies of the frontline social care staff consent form can be ordered using product code COV2020408V2.

Copies of the social care worker consent form are available to order using product code COV2020370V2.

The COVID-19 consent form letter templates are available in different software versions and can be downloaded and adapted to suit the needs of local healthcare teams.

Health publications orderline

Immunisation Publications
UK Health Security Agency, 61 Colindale Avenue, Colindale
London
NW9 5EQ

Contact form https://www.healthpubl...

Telephone: 0300 123 1002

Copies of printed publications and the full range of digital resources to support the immunisation programmes can now be ordered and downloaded online. Log in to register and place your order.

Published 7 December 2020
Last updated 26 January 2021 + show all updates

1. 26 January 2021

   Updated frontline social care letter template and information on use of consent forms.

2. 21 January 2021

   Updated consent forms.

3. 6 January 2021

   Added letter template for frontline social care staff.

4. 31 December 2020

   Added new consent form for frontline social care workers.

5. 17 December 2020

   Added open source and MS word versions of the consent form.

6. 7 December 2020

   First published.