Arizona COVID-19 Vaccine Information

COVID-19 Vaccine Prioritization AZ 2021 01 11

Employer Request Form:

Qualify your firm as an Essential Business

ADHS has created a  survey for consideration to receive COVID-19 vaccine when available. This form is intended for employers of Phase 1B essential workers* to attest that they meet the prioritization criteria and request a COVID-19 vaccine allocation for their workforce. In order to be considered for a vaccine allocation during Phase 1B when vaccine is available, employers are encouraged to share their vaccination plans including how many essential employees require vaccination.

Phase 1B will include essential workers defined in VAPAC recommended guidance (based on CISA and EO 2020-12 definitions), and groups will be sub-prioritized while vaccine supplies are limited to include risk of exposure and mission critical positions.

Please note that the sub-prioritization process will be based on vaccine availability, local allocation and risk assessment of each group. It is recommended that employers consider their continuity of operations plans while completing this form.

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CDC Information Page – Coronavirus.gov

CDC Information Page – Coronavirus.gov

Click the image above to visit Coronavirus.gov

Arizona Department of Health Services Information

Arizona Department of Health Services Information

Click the image to visit the Arizona Department of Helth Services website at AZDHS.gov/Coronavirus

Tool Kit for Businesses

Tool Kit for Businesses

The Biotechnology Innovation Organization (BIO) has set up and is maintaining current and useful guidance for employers. Click the image to access the information.

Need Assistance? Call 211

Need Assistance?  Call 211

If you need assistance finding food, paying housing bills, accessing free child care, or other essential services, dial 211 on your phone. For more information, click the image to learn more. (211 is a community service supported by the United Way.)