Weekly HCP & Resident COVID-19 Vaccination

Data Collection Forms and Instructions

All Data Collection Forms are Print-only

• Monthly Reporting Plan (57.141) pdf icon[PDF – 80 KB] – September 2021
  • Table of Instructions pdf icon[PDF – 220 KB]
• Weekly COVID-19 Vaccination Summary Form for Residents at LTCFs (57.218) pdf icon[PDF – 120 KB] – September 2021
  • Table of Instructions pdf icon[PDF – 300 KB]
• Weekly COVID-19 Vaccination Summary Form for Healthcare Personnel at LTCFs (57.219) pdf icon[PDF – 150 KB] – September 2021
  • Table of Instructions pdf icon[PDF – 350 KB]

CSV Data Import

• Uploading Group COVID-19 .CSV Data Files (10.0) pdf icon[PDF – 1 MB] – September 2021
• Uploading Group COVID-19 .CSV Data Files (Pre 10.0) pdf icon[PDF – 1 MB] – August 2021
• Residents of LTCFs COVID-19 Vaccination Data
  • CSV File Template (10.0 and Pre 10.0) excel icon[CSV – 2 KB] – August 2021
  • Example CSV File (10.0) excel icon[CSV – 1 KB] – September 2021
  • Example CSV File (Pre 10.0) excel icon[CSV – 2 KB] – August 2021
• Healthcare Personnel of LTCFs COVID-19 Vaccination Data
  • CSV File Template (10.0) excel icon[CSV – 3 KB] – September 2021
  • Example CSV File (10.0) excel icon[CSV – 3 KB] – September 2021
  • CSV File Template (Pre 10.0) excel icon[CSV – 2 KB] – August 2021
  • Example CSV File (Pre 10.0) excel icon[CSV – 2 KB] – August 2021

Data Tracking Worksheets

• Data Tracking Worksheet Quick Reference Guide pdf icon[PDF – 600 KB] – May 2021
• New! Data Tracking Worksheet for COVID-19 Vaccination among Residents excel icon[XLS – 8 MB] – January 2022
• New! Data Tracking Worksheet for COVID-19 Vaccination among Healthcare Personnel excel icon[XLS – 8 MB] – January 2022