|Pre-vaccination screening checklist|
This checklist helps decide about vaccinating you or your child today. Please fill in the following information for your immunisation provider.
Where appropriate, the Zostavax screening tool and/or the special COVID-19 checklist may also need to be used in conjunction with this screening checklist.
Name of person to be vaccinated:
Date of birth:
Name of person completing this form:
Please indicate if the person to be vaccinated:
Note: Please discuss this information or any questions you have about vaccination with your immunisation provider before the vaccines are given.
Before any vaccination takes place, your immunisation provider should ask you:
It is important for you to receive a personal record of your vaccinations or your child’s vaccinations. If you do not have a record, ask your immunisation provider to give you one. Bring this record with you every time you or your child visit for vaccination. Make sure your immunisation provider records all vaccinations on it. An AIR record is an acceptable example of personal record.