Planning guidance for immunization clinics for COVID-19 vaccines

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Introduction

The purpose of this document is to assist in planning immunization clinics for COVID-19 vaccines during the COVID-19 pandemic. Once COVID-19 vaccines are approved and available for use in Canada, they will need to be administered as quickly as possible according to allocation plans. Although they are not the only means of offering COVID-19 vaccines, immunization clinics offer the ability to immunize large numbers of people over a short period of time. The primary target audience for this document is immunization program planners of local/regional and provincial/territorial (PT) public health departments and federal health departments with responsibility for immunization programs. This document should be read in conjunction with other relevant jurisdictional (federal, provincial/territorial (FPT) and/or local) immunization program legislation, regulations, policies and planning documents. This planning guidance is meant to complement existing jurisdictional immunization campaign and clinic plans, and provides ideas and suggestions for consideration which may or may not be appropriate in particular settings and contexts.

Implementing immunization clinics is a large-scale operation which requires detailed planning, coordination, collaboration and efficiency. Typically in immunization clinics a large number of clients are being immunized, so any inefficiency in the processes can significantly decrease the clinic's capacity to safely immunize the optimal number of people. Any major incident (e.g., major injury requiring emergency medical services or technological problem) at a clinic can delay the receipt of immunizations and negatively impact the clients' confidence in the process. Building public confidence in vaccines will be even more important during the COVID-19 immunization clinics with the rollout of new vaccines.

This document builds on Appendix B of the Vaccine annex: Canadian Pandemic Influenza Preparedness: Planning Guidance for the Health Sector. In the current context of the COVID-19 pandemic, planning is required to prevent COVID-19 infection of clinic staff, volunteers and clients. Larger clinics with more Immunizers are generally more efficient at vaccinating higher numbers of clients, however, in the context of COVID-19 community transmission, the need to maintain physical distancing and prevent crowding will be very important in determining the size and flow of people within immunization clinics. This document incorporates the recommendations of the Public Health Agency of Canada's (PHAC) Guidance for influenza vaccine delivery in the presence of COVID-19 as applicable to COVID-19 immunization. It also builds on the National Advisory Committee on Immunization's (NACI) Recommendations on the Duration of the Post-vaccination Observation Period for Influenza Vaccination during the COVID-19 Pandemic.

Although the focus of this guidance document is on immunization clinic planning, some information and resources are provided regarding alternate vaccine delivery methods. Issues related to vaccine availability and prioritization/eligibility are beyond the scope of this document, however it should be noted that COVID-19 vaccines are expected to be available progressively over time in a sequenced roll out and clinics may have specific eligibility criteria depending on vaccine availability. It is anticipated that authorization of COVID-19 vaccine use for children and pregnant women will come later in the campaign.

Clinic planning

Leadership and coordination

Planning and implementation of immunization clinics requires experienced leadership and the coordination of many community groups and individuals. Clinic leadership will need to be established to provide overall management, planning and coordination of clinic operations, as well as knowledge of public health practices and infection prevention and control to prevent the transmission of COVID-19.

A key aspect of leadership and coordination will be to identify areas where collaboration may be required and, where possible, to negotiate agreements in advance (e.g., collaboration with owners of facilities to secure clinic sites, with human resources and unions for rapid hiring and addressing staffing impacts, and with health professional associations for human resources surge capacity). While the Government of Canada has purchased sufficient quantities of some supplies to immunize all Canadians (including syringes, needles, alcohol swabs, bandages, gauze and sharps containers), arrangements will need to be put in place with suppliers for other required supplies.

Collaborations for clinic implementation may include arrangements related to the following:

In developing these collaborations, consider the needs and resources of the community. Planning should consider the diverse needs of the community to be served including age, gender, ability status, culture, language, religious beliefs and other social and demographic factors. It is recognized that each jurisdiction has its own health system infrastructure and planners will need to align clinic plans in accordance with systems that exist in their jurisdiction.

Immunization campaign and clinic planning parameters

Immunization campaign planning begins with determining the number of people to be immunized. The number of people to immunize are then used to plan the number of clinics required and the number of staff and volunteers at each clinic. The following parameters to support planning are outlined below:

When vaccine quantities are limited, the number of doses available and the groups that are eligible to receive the vaccine will also need to be considered when planning immunization clinics.

See Table 2 for a description of the staffing/volunteer roles that are referred to below. Note that the numbers below are rough estimates and suggestions, and may need to be adjusted depending on local circumstances and community needs.

Number of vaccine doses an Immunizer can give per hour (immunization rate)

The number of Immunizers depends on the available supports (such as Clinic Leaders) and the size of the clinic space

Duration of each clinic

Number of clinics per day and per week

Other planning parameters for staffing

Planning for second doses

Immunization clinic site identification

Identifying appropriate sites for immunization clinics requires selecting sites that meet the needs of the community and support clinic objectives and activities safely and securely. Location, accessibility and amenities should be considered when selecting clinic sites, as outlined in table 1 below. The same clinic sites can be used for the entire duration of the immunization campaign, or different clinic locations may be chosen at different times to facilitate access.

If using school sites for immunization clinics, it is best to run the clinics when the students are not present (i.e., late afternoon or evening, or weekends). As clients often arrive early for clinics, it will be important to ensure that client do not enter the school or interact with students or school staff members if they are present in the building.

Table 1: Examples of clinic site considerations
Location Accessibility Amenities
  • Familiar/recognizable to the public/community
  • Centrally located in an area with high population density
  • Near communities with populations at increased risk for COVID-19 or who may have limited access to transportation (e.g., placing clinics in communities with lower average income or higher numbers of racial minorities, near food banks, nursing homes or shelters)
  • In culturally safe locations (e.g., Friendship Centres)
  • Parking space (enough to maintain traffic flow)
  • Easily reached by public transportation with short travel times
  • Accessible for families, older adults and people with disabilities (i.e. wheelchair accessible)
  • Easy to transport supplies to and from site
  • Very large, open areas for seating, immunization stations and waiting after immunization
  • Ability to manage one way flow through the clinic (separate entrance and exit)
  • Good lighting and very good ventilation (particularly important during the COVID-19 pandemic)
  • Washroom facilities (for public and staff)
  • Separate rooms for secure storage (for supplies and staff belongings separately)
  • Separate large well ventilated room for staff breaks (if staff remaining in the building for breaks)
  • Access to electricity to support refrigerators, computers/laptops, printers
  • Access to internet
  • Indoor capacity suitable to hold those waiting in line (although waiting in line should be minimized during COVID-19) with some seating for those who cannot stand
  • Separate access for receiving/loading supplies
  • Physical barriers to prevent spread of respiratory droplets, if available
  • Sufficient chairs, tables, privacy dividers, garbage cans
  • Separate/private First Aid area for managing medical situations

Examples of potential clinic sites include:

In addition, with appropriate equipment (e.g., tents, heaters), outdoor areas such as sports fields and parking lots can be used as potential immunization clinic sites.

When selecting sites, consider challenges that could be encountered and plan accordingly through the use of site visits and clinic implementation exercises, if possible. These challenges can include security issues if the public enters restricted areas, competition for parking spaces with other site users, conflict with other users (e.g. activities in arenas or school gymnasiums), limited storage space, damage to facilities and issues related to malfunctioning of essential systems such as water, electricity, internet connectivity and washrooms. If there is a possibility that clients will need to wait outside during the winter or inclement weather, consider options such as tents and heaters.

Human resources

Clinic staffing

Immunization clinics require many human resources to facilitate effective operations. The number of personnel normally assigned to routine public health immunization programs will be insufficient to respond to COVID-19 immunization requirements, therefore securing additional staff will be necessary.

Additional sources of health care provider staffing for immunization and/or pre-loading syringes may include:

In some jurisdictions, the scope of practice for some of the above providers may preclude their ability to immunize.

The inclusion of non-health care provider public health unit staff, other allied health professionals and volunteers, will help fill the non-health care provider roles required for an effective and efficient clinic. Assignment of activities and requirements for supervision will depend on each jurisdiction's specific regulations and/or policies and the individual's level of competence and experience.

Legislation and regulatory considerations

Immunization clinics utilize a broad range of staff and volunteers, including regulated health professionals. Each jurisdiction will have legislation and regulations governing the practice of health care professionals and delegation of authority within its jurisdiction, which should be considered in clinic staffing and assignment of roles and responsibilities. Additionally, based on jurisdictional requirements, medical directives to delegate the authority to immunize may need to be written, depending on the types of staffing used in the clinic.

Roles and responsibilities

Table 2 provides examples of clinic roles and activities in immunization clinic operations. Depending on the clinic setting and the size of the clinic and resources and needs of a community, some of these roles may be combined or excluded. Clarify which roles and activities will be carried out at headquarters/ the main office of the clinic organizers and which are required on site at the clinic locations. Many of the planning function will require a team approach, although only the lead position is listed below.

Table 2: Examples of clinic roles and activities in immunization clinic operations
Role Activities
Campaign and clinic planning which can generally be performed at headquarters/main office and not at clinic locations
Immunization campaign leader
Role often performed by a director or manager with experience in immunization
  • Ultimately responsible for the overall operations of the immunization campaign and clinics.
  • Oversees all aspects of clinic planning, implementation and operation to ensure an efficient, client-focused and safe clinic, including ensuring professional competency, appropriate infection prevention and control, and cultural safety and inclusivity.
  • Serves in a liaison role and responds to community leaders.
  • Ensures appropriate training materials are available for staff members in advance of clinics.
  • Works with the staff in charge of logistics and/or specialized support function, ensures appropriate supplies, including vaccines, for each clinic.
  • Ensures that policies are in place to maintain infection control.
  • Coordinates communication with staff.
  • Trouble-shoots problems/concerns that arise.
Medical support
Role often performed by medical health officer or other physician
  • Writes the medical directives under which vaccines are administered for health care professionals who require delegation to immunize.
  • Writes the medical directive for the management of anaphylaxis and advises on polices to manage other medical issues that may occur at a clinics such as fainting.
  • Creates or approves the Vaccine Information Sheets, Consent Forms and After-Care Sheets for clients.
  • Creates or approves training materials/in-services, particularly for Immunizers, Syringe Pre-Loaders and other health care providers, including on fainting and anaphylaxis management.
  • Reviews reported adverse events following immunization and provides recommendations regarding the second vaccine dose (if that is needed).
  • If Medical Support if not available at the clinics, available by telephone to assist with questions, including with regard to contraindications and precautions.
  • Advises on COVID-19 related screening protocols and infection prevention and control precautions.
Human resources/scheduling
  • Supports recruitment of necessary external staff and volunteers.
  • Ensures appropriate information needed for onboarding is obtained from external staff members who will be working at the clinics.
  • Obtains and verifies credentials of external regulated health professionals.
  • Verifies current cardio-pulmonary certification (CPR) for health care providers (as per provincial/territorial requirements).
  • Obtains staff immunization information and hepatitis B titre results for new staff and existing staff if results not already on file (if possible and available), and promotes appropriate immunization for volunteers. This function can be performed by occupational health if that role is available.
  • Ensures staff and volunteers are aware of the need for and can wear personal protective equipment (i.e., mask and eye protection) throughout the clinic shift.
  • Schedules all the required staff and volunteers for each clinic and ensures that staff and volunteers are aware of the date, time and location of clinics they are scheduled for and who to contact if changes to a scheduled shift are required.
  • Manages any schedule changes among staff and volunteers. Develops contingency plans for last minute sick calls or when staff or volunteers do not show up for their shift, such as a roster of urgently available staff.
  • Ensures staff and volunteer liability issues are addressed.
Finance
  • Supports the procurement of the necessary equipment, supplies and site locations for the clinics.
  • Creates forms and processes to track compensation (e.g., for external staff, overtime).
  • Ensures that financial matters are addressed according to procedures.
  • Collects and processes time sheets and invoices.
  • Tracks spending and seeks appropriate budget approval as needed.
Logistics
Role can be performed by someone with logistical experience who understands procurement, immunization, the organization and the community
  • Oversees and manages logistical planning and operations of clinics including:
    • clinic site selection
    • pre-planning clinic site setup if possible, and setting up clinics in fixed sites in advance of the clinics starting, including any accessibility accommodations
    • acquiring supplies and vaccines (in collaboration with Immunization Campaign Leader and Specialized Support Functions)
    • packing supplies for initial set-up and re-supplying of the clinics
    • transportation of supplies and vaccines to and from clinics, including how to accommodate the need for urgent supplies and/or vaccines
    • equipment and processes for cold chain management of vaccines
    • biomedical waste management (e.g., of sharps containers)
    • telephone translation services if on site translators are not available
Administrative support
  • Provides administrative support to the clinic planners, as required.
  • Involved in ordering, packing and organizing clinic supplies and forms.
Epidemiology/data base support
  • Determines how information on clinic clients will be recorded and analyzed (see Section on Data Management).
  • Determines how information on each clinic will be recorded (see Section on Data Management).
  • Determines how local/provincial and federal data reporting requirements will be met.
IT support
  • If clinics are using electronic recording and information systems, IT support will be required to ensure:
    • internet connectivity
    • appropriate equipment
    • proper functioning of the equipment
    • privacy and security of the information
    • back-up systems
    • access to rapid support when issues arise
Specialized support functions
Role can be performed by a health care provider familiar with infection prevention control or occupational health and safety and cold chain management
  • Supports planning for specialized functions which can include:
    • infection prevention and control/ occupational health and safety
    • cold chain management (particularly for vaccines with specific cold chain requirements) and supports training of other staff with regard to cold chain management requirements including management of dry ice if required
    • vaccine inventory management (in collaboration with Logistics and Immunization Campaign Leader)
Communications officer
  • Develops communications materials regarding the immunization campaign which may include media briefings, websites, social media and media buys.
  • Advises media outlets, updates the websites and uses social media to advise the public regarding eligibility criteria for the clinics (if available vaccine doses are limited), clinic locations, dates, hours, need for appointments or not, what to bring with them, the accessibility of the site and other relevant information.
  • Serves as first point of contact with media and arranges media interviews with the appropriate spokespersons.
  • Develops a media/communications protocol to ensure clinic staff/volunteers are apprised of how to respond to media visits to the clinic and/or questions.
  • Ensures that written materials are translated into appropriate languages, are culturally appropriate and written at an appropriate reading level.
  • Informs local emergency personnel and nearby hospitals of the dates, times and locations or each clinic.
On-site clinic activity
Parking lot attendants
Role can be performed by a volunteer, security guard or non-health care provider staff member
  • Maintains parking lot traffic flow.
  • Directs clients appropriately.
  • Can help with obtaining assistance from clinic nurses/Medical Support if clients are waiting in their vehicles post-immunization and need assistance, along with the Post-Immunization Waiting Area Monitors who would be monitoring the parking lot in this model.
Security
Role can be performed by a hired security guard or provided by the site.
  • Facilitates safety of staff, volunteers and clients, as well as the clinic property and equipment.
  • Assists in maintaining physical distancing, crowd control and clinic flow.
  • Intervenes as required if security issues arise.
  • Ensures that all staff/clients have left the site after clinic hours.
  • Ensures security of the clinic location, onsite vaccine and other supplies and equipment after the clinic has ended.
  • At least two security guards are recommended per clinic.
Clinic leaders
Role often performed by managers or senior nurses or other nurses with immunization experience
  • Responsible for the overall operations of the clinic.
  • Ensures assigned staff attend clinic and record attendance for payment purposes (may include signing time sheets).
  • Ensures staff are aware of their assigned roles and oversees and monitors all clinic staff activity.
  • Provides onsite clinic orientation/staff education prior to the start of the clinic and facilitates staff debrief at the end of the clinic, if these activities are being done at the clinic site.
  • Confirms that staff and clinic protocols are followed.
  • Can support infection prevention and control, occupational health and safety, cold chain and vaccine inventory monitoring functions (if separate staff not assigned to the Clinic Specialized Support role).
  • Serves as the onsite media spokesperson.
  • Responds to questions from clients during the screening or registration process, including clients with questions about the vaccine or immunization process, or clients who fail the COVID-19 screening, are not eligible for immunization based on the criteria of the clinic or have contraindications.
  • Trouble-shoots problems/concerns that arise.
  • Supports and promotes cultural safety, diversity, and inclusion in serving clients and among staff.
Clinic floaters
Role often performed by senior nurses or other nurses with immunization experience
  • Assists the Clinic Leaders in their role and can serve as Clinic Leader if needed.
  • Ensures that protocols are followed during clinic activities.
  • Provides support to newer Immunizers.
  • Trouble-shoots and responds to medical questions or concerns from clients, staff and volunteers.
  • Lead contact for post-immunization adverse events (e.g., fainting and anaphylaxis management) and other medical emergencies (if a separate Medical Support staff is not assigned or available). Reports adverse events such as anaphylaxis that occur during the clinic to the appropriate public health officials if indicated.
  • Responds to questions from clients during the screening or registration process, including clients with questions about the vaccine or immunization process, or clients who fail the COVID-19 screening, are not eligible for immunization based on the criteria of the clinic or have contraindications.
  • Can support infection prevention and control, occupational health and safety, cold chain and vaccine inventory monitoring functions (if separate staff not assigned to the Clinic Specialized Support role).
  • If needed, can provide back-up as Immunizer or Syringe Pre-Loader.
Greeters
Role can be performed by a non-health care provider staff member or volunteer; could also be done by a health care provider
  • Welcomes clients and monitors line-ups to maintain physical distancing.
  • Asks if client has an appointment (if clinic is appointment-based) and if client meets the eligibility criteria for the clinic (if there are eligibility criteria for the clinic based on who is being prioritized for immunization).
  • Screens for any COVID-19 related symptoms as per the clinic and jurisdiction's active and passive screening protocols.
  • Refers clients who fail the screening protocol or have questions to the appropriate staff member (e.g., Clinic Leader, Clinic Floater, Medical Support).
  • Ensures clients arriving at the clinic are wearing a mask (unless less than 2 years of age, or cannot wear a mask) and that they clean their hand with alcohol-based hand rub. Provide a mask to clients who do not have one.
  • Determines whether the client has any accessibility needs (e.g., mobility issues, sight or hearing impaired, need for a translator) that require additional supports and refers to the appropriate staff member (e.g., Clinic Leader, Clinic Floater, Medical Support).
  • Directs clients to registration.
  • Facilitates crowd control and clinic flow, ensuring physical distancing of at least 2 metres is maintained between clients while waiting in line to enter the clinic or in the pre-registration area (although clients from the same household can remain together) with the aid of markings on the ground.
  • Ensures that signage is in place and visible, including COVID-19 screening protocols, eligibility criteria, clinic instructions and clinic flow, as appropriate.
Registration
Role often performed by administrative assistants, particularly if being done electronically
  • Verifies the client's appointment (if the clinic is appointment-based).
  • Depending on the registration process used by the clinic, verifies registration documents (e.g., Consent Form) have been completed online, or assists with their electronic completion or provides paper documents for completion. If required for registration, checks the health card or other identification.
  • Refers clients to appropriate clinic staff members for discussion of any potential contraindications to immunization or questions (e.g., Clinic Leader, Clinic Floater, Medical Support).
Syringe pre-loaders

Only needed in clinics where pre-loading occurs by non-Immunizers

Role could be performed by a nurse, registered practical nurse, pharmacist

  • Mixes vaccine with appropriate diluent or adjuvant (depending on the vaccine) using appropriate aseptic technique as per the Canadian Immunization Guide.
  • Pre-loads the syringe with the appropriate dose and attaches the needle for administration using appropriate aseptic technique as per the Canadian Immunization Guide.
  • Ensures that sufficient vaccine is pre-loaded to keep the clinic running efficiently, but not too much is preloaded in order to prevent wastage.
  • Ensures vaccines are kept according to appropriate cold chain requirements during the mixing and pre-loading processes and after pre-loading, with appropriate temperature monitoring and recording.
Runners
Role could be performed by administrative assistants, non-health care provider staff members or volunteers
  • In clinics where syringe pre-loading occurs by non-Immunizers, monitors the supplies of pre-loaded syringes that each Immunizer has and needs, and delivers preloaded syringes with the attached needle from the Syringe Pre-Loader to the Immunizers in a container (e.g., small box with no lid).
  • Monitors and delivers other required equipment to Immunizer or Syringe Pre-Loaders and responds to staff requests.
  • If using a paper-based system, collects completed consent forms from Immunizers.
  • At the end of the clinic, completes inventory count for ancillary supplies, forms and other equipment and provides replenishment numbers needed for the next day's clinic (if using the same site) to Administrative Support (below).
Client flow monitors
Role could be performed by volunteers or non-health care provider staff members
  • Directs clients who have registered to the next available Immunizer.
  • Ensures clients waiting in line for the next Immunizer are physically distanced with the aid of markings on the floor indicating where to stand and/or where chairs are placed to sit.
  • If clinic is operating by calling pre-registered clients in from their vehicle or outside, performs this function.
Immunizers
Role can be performed by nurses, doctors, paramedics, pharmacists, dentists, registered practical nurses, nursing and medical students, midwives (depending on jurisdictional requirements and legislation)
  • If syringes are pre-loaded by Syringe Pre-Loaders, verifies volume in the syringe. If Immunizer is loading the syringes, verifies that they have sufficient supply for the next client.
  • Signals that they are ready for the next client using a flag, waving their hand or other mechanism.
  • Verifies client matches the consent form information and that informed consent has been obtained; screens for illness and any contraindications and answers client's questions or concerns.
  • Assesses client to determine if they have a history of fainting during medical procedures, or look anxious, pale or sweaty. These clients may require immunization lying down on a mat in the First Aid Area or in a reclining chair (if available) to prevent fainting and injury.
  • Using appropriate techniques (including hand hygiene, land-marking), immunizes the client.
  • Following immunization, activates safety engineered device and then immediately disposes of the needle and syringe in the sharps container.
  • Completes documentation for the clinic record and for the client.
  • Provides client with their Immunization Record and After-Care Sheet.
  • Counsels clients about post-immunization waiting period, monitoring for adverse events, what to do if adverse events develop, need for and timing of a second dose (if needed), and the need to continue to follow COVID-19 precautions (e.g., physical distancing, mask use) on an ongoing basis as per public health recommendations.
  • Ensure clients can safely proceed to the Post-Immunization Waiting Area.
  • Responds to adverse events if required; documents and reports adverse events and informs appropriate clinic staff (e.g., Clinic Leader, Clinic Floater, Medical Support).
Medical support
Role can be performed by a physician, nurse practitioner or nurse specifically assigned to this role
  • Responds to questions from clients during the screening or registration process, including clients with questions about the vaccine or immunization process, or clients who fail the screening, are not eligible for immunization based on the criteria of the clinic or have contraindications.
  • Monitors/responds to post-immunization adverse events and other medical emergencies.
  • Supervises clients who need extra medical attention after immunization.
  • Manage needle stick injuries by assisting to arrange testing of the source person and discussing the needs for post-exposure management in the exposed person.
Post-immunization waiting area monitors
Role can be performed by health care providers or by non-health care provider staff members or volunteers who inform health care providers if assistance is needed
  • Monitors Post-Immunization Waiting Area, including for clients who may be unwell and need assistance after immunization.
  • Ensures that clients maintain 2 metre distance and continue to wear their masks.
  • If clients are waiting in their vehicles or outside after immunization, monitors this outside area.
  • If role is performed by non-health care providers, informs a clinic health care provider (e.g., Clinic Leader, Clinic Floater, Medical Support) immediately if a client needs medical attention.
  • Advises clients to use alcohol-based hand rub on exiting the clinic.
Administrative support
  • Performs or oversees registration process.
  • Collects all documentation including consent forms and adverse event forms (if paper-based systems are being used).
  • Enters any forms that are used into electronic system, depending on processes used at the clinic.
  • Ensures that medical information and Consent Forms are secured and remain confidential.
  • Provides training and oversight to volunteers who are performing the roles of Parking Lot Attendants, Greeters, Client Flow Monitors and Post-Immunization Waiting Area Monitors.
  • Assists with data collection for the clinic information including numbers vaccinated, and supplies and vaccines used and needed.
  • With Runners, at the end of the clinic, prepares re-order forms for ancillary supplies, client forms and other equipment that require replenishing for the next day's clinic if using the same site.
  • Assists Clinic Leaders with tracking staff attendance and collecting time sheets, and tracking volunteer attendance.
Clinic specialized support
Role can be performed by a staff member familiar with infection prevention control or occupational health and safety and cold chain management
  • Supports:
    • infection prevention and control/occupational health and safety at the clinic
    • cold chain management (particularly for vaccines with specific cold chain requirements including the appropriate handling of dry ice, if required)
    • vaccine inventory management at the clinic
    • collaborates with custodial staff regarding cleaning and disinfection protocols
    • other functions such as answering client's questions, assisting with managing fainting or anaphylaxis and monitoring the Post-Immunization Waiting area
Clinic support (roles that assist clinic staff as needed to efficiently deliver and maintain clinic activities)
Translators / interpreters
Trained translators optimal, but can use health care providers or volunteers who speak the required language
  • Assists clients in understanding the immunization information and processes in their specific language.
  • Particularly important in clinics serving diverse population who many not speak English or French (depending on jurisdiction).
  • If onsite translators/interpreters are not available, telephone translation services can be used.
Custodial staff
Can be provided by the facility operating the site
  • Ensures that site is clean and in proper working order (e.g. washrooms are cleaned and stocked, garbage is collected).
  • Frequently cleans and disinfects commonly touched surfaces.
Table 3: Examples of a possible clinic staffing plan
Example of the staffing to vaccinate approximately 1,000 people at a clinic

The example provided below is an estimate of the number of staff for the key functions that could be used to vaccinate approximately 1,000 people during an immunization clinic. It assumes that:

  • the clinic is open to the public for six hours and each Immunizer has a half hour break
  • the vaccines are pre-loaded for the Immunizers and consent forms have already been completed
  • there is a continuous flow of clients
  • the immunization rate is 14 immunizations per Immunizer per hour, and
  • there are 13 Immunizers

These are rough estimates and may need to be adjusted to accommodate how the clinic is operating (e.g., online or onsite registration, pre-loaded syringes or syringes loaded by Immunizers), staff experience, the needs of the community, the size of the clinic site, and the available human resources.

Estimated numbers of staff:

  • 3 leadership roles (e.g., 2 Clinic Leaders and 1 Clinic Floater)
  • 13 Immunizers (e.g., nurses, physicians, paramedics, pharmacists) for assessing clients before immunization, answering questions, immunizing, recording information, and managing adverse events
  • 4 Syringe Pre-Loaders if vaccine requires mixing; 3 syringe pre-loaders if vaccine does not require mixing
  • 9 volunteers or other non-health care provider staff members: 2 Parking Lot Attendees, 3 Greeters, 2 Client Flow Monitors, 2 Post-Immunization Waiting Area Monitors
  • 5-6 Administrative Assistants: 3-4 Registration (depending on how much of the registration process is done online before the client arrives at the clinic), 2 Runners
  • 1 Clinic Specialized Support person to manage infection prevention and control, occupational health and safety, vaccine inventory and cold chain monitoring
  • 1 Medical Support (optional)
  • 2 Security personnel
  • 1 Custodial staff
  • Translators or interpreters as needed
Example of the staffing to vaccinate approximately 450 people at a clinic

The example provided below is an estimate of the number of staff for the key functions that could be used to vaccinate approximately 450 people during an immunization clinic. It assumes that:

  • the clinic is open to the public for six hours and each Immunizer has a half hour break
  • the vaccines are pre-loaded for the Immunizers and consent forms have already been completed
  • there is a continuous flow of clients
  • the immunization rate is 14 immunizations per Immunizer per hour, and
  • there are 6 Immunizers

These are rough estimates and may need to be adjusted to accommodate how the clinic is operating (e.g., online or onsite registration, pre-loaded syringes or syringes loaded by Immunizers), staff experience, the needs of the community, the size of the clinic site, and the available human resources.

Estimated numbers of staff:

  • 2 leadership roles (e.g., 2 Clinic Leaders)
  • 1 Clinic Floater (optional)
  • 6 Immunizers (e.g., nurses, physicians, paramedics, pharmacists) for assessing clients before immunization, answering questions, immunizing, recording information, and managing adverse events
  • 2 Syringe Pre-Loaders (same number if mixing required or not)
  • 5 volunteers or other non-health care provider staff members: 1 Parking Lot Attendees, 2 Greeters, 1 Client Flow Monitors, 1 Post-Immunization Waiting Area Monitors, 1 spare for back-up and to cover breaks
  • 4 Administrative Assistants (2 Registration, 1 Runners, 1 spare for back-up and to cover breaks)
  • 1 Clinic Specialized Support person to manage infection prevention and control, occupational health and safety, vaccine inventory and cold chain monitoring (role could be combined with Clinic Leaders, Clinic Floater or Medical Support)
  • 1 Medical Support (optional)
  • 2 Security personnel
  • 1 Custodial staff
  • Translators or interpreters as needed
Practical tips for remote and isolated communities
  • Because of the limited number of health care workers in these communities, surge capacity from outside the community may be required in addition to volunteers from within. These individuals should have appropriate cultural awareness training and be sensitive to the needs of the community.
  • Some of the roles above may be combined in smaller clinics.

Orientation and training

Providing thorough staff orientation and training prior to the first clinic is vital to the effective functioning of immunization clinics. Staff and volunteers should be oriented to relevant administrative requirements such as:

Staff and volunteers should also receive training on general issues related to clinic functioning and their specific roles and responsibilities. See Table 4 for some general issues to cover for all clinic staff.

As possible, develop clinic orientation and training manuals and materials, outlining all aspects of clinic operations. Orientation materials may include the administrative information described above, as well as the following:

Role specific training materials can also be provided for key roles performed by various staff members. For example, materials for:

See Table 4 for some training topics for all staff and some of the health care provider roles.

Provide orientation and training through multiple channels and offer numerous opportunities for participants (e.g., online sessions that are self-directed or part of scheduled online meetings; written materials; opportunities to ask questions; group chat functions). Consider using checklists based on the roles the individual will fulfill to ensure that all aspects of orientation and training are covered. If time permits and as needed, consider a dry-run exercise to reinforce training for all roles involved in the clinics, including the management of fainting and anaphylaxis.

If applicable based on jurisdictional requirements, ensure that processes are in place to provide specialized training as required for staff (e.g., immunization certification, infection prevention and control, handling sharps, storage and handling of vaccines, data entry programs, anaphylaxis management, cardio-pulmonary resuscitation (CPR)) in advance of clinic opening. Although specific health care providers at the clinic are designated to manage fainting and anaphylaxis (e.g., Clinic Leader, Clinic Floater, Medical Support), all health care providers should be trained in fainting and anaphylaxis management and have up-to-date CPR (based on provincial/ territorial/ local requirements).

'Just in time' orientation and staff training in advance of beginning the clinic can focus on:

To avoid aggregating of staff members, consider providing this information in advance of the clinic via email or at the clinic individually to each staff member. If staff do need to aggregate for 'just in time' orientation at the clinic, to minimize the risk of COVID-19 infection, ensure physical distancing and that medical masks and eye protection (e.g., face shields) are worn at all times, avoid shouting and keep the sessions as short as possible.

Consider specific support for staff who are new to the immunization clinic such as special attention from the Clinic Leader or Clinic Floater, or a buddy system with a more experienced staff member.

Table 4: Possible topics to be covered during training for all staff and health care providers

For all staff

  • The roles and responsibilities of all clinic staff and clinic flow.
  • Administrative details such as human resource forms, scheduling, time sheets, who to call regarding shift changes or other questions, if food and beverages will be provided for breaks, appropriate clothing to wear and appropriate footwear.
  • Cultural and diversity sensitivity (need for privacy during immunization for some cultures, supporting people who only speak languages other than English or French (depending on the jurisdiction), assisting people with physical or developmental disabilities or mental health concerns, using appropriate and sensitive language).
  • Infection prevention and control recommendation and other occupational health and safety issues (e.g., hand hygiene, recommended immunizations for staff and volunteers, the required personal protective equipment and how to properly use the equipment, how to prevent and report needle stick injuries and falls).
  • Managing people who do not meet the eligibility criteria, who fail screening for COVID-19 or who do not comply with wearing a mask or physical distancing.
  • Managing people who have concerns or complaints or who are upset or angry.
  • How to recognize and manage possible abuse (of children, partners, or staff).
  • Where to direct requests from the media.

Additional training specific for health care providers (e.g., Immunizers, Syringe Pre-Loaders, Medical Support, Clinic Specialized Support, Clinic Floater, Clinic Leader)

  • Information about COVID-19 and the available vaccines to be able to respond to client questions, including questions from those who are hesitant about receiving the vaccine.
  • Strategies to manage pain and fear in vaccine recipients, including children.
  • How to determine capacity to consent based on age or cognitive functioning.
  • How to assist parents in appropriately holding young children for immunization.
  • How to seek informed consent, counsel clients and identify contraindications, prepare and administer the vaccine (including appropriate land-marking) dispose of the used needle and syringe, and conduct post-immunization counseling.
  • How to perform appropriate documentation for the clinic and the client.
  • How to identify and manage a client who may faint, and how to manage fainting and anaphylaxis.
  • How to prevent and manage needle stick injuries.
  • Proper storage and handling of the COVID-19 vaccines for staff members in specific roles (e.g., Clinic Specialized Support, Clinics Floater, Clinic Leaders), including the appropriate handling of dry ice, if required.
  • Refresher on CPR if needed.

Additional training specific for clinic leaders

  • How to respond to scenarios such as power outages or other reasons for loss of IT functions.
  • How to managing challenging public relations issues (e.g., client not adhering to infection prevention and control requirements, long waits, large crowds, angry clients, client complaints, client injuries).
  • Management of media requests and onsite media visits.
  • Reporting of adverse events that occurred during the clinic to public health officials.

For additional information on training content and tools for immunizers, see the suggested links below:

Infection prevention and control

Immunization clinics for COVID-19 vaccines are likely to be taking place while ongoing transmission of COVID-19 is occurring in the community. Preventing transmission of infection at clinic sites is essential. The Public Health Agency of Canada (PHAC) has developed Guidance for influenza vaccine delivery in the presence of COVID-19, which outlines strategies which are also relevant to COVID-19 immunization clinics. Some key infection prevention and control strategies are as follows:

Staff and volunteer immunizations: The following immunizations are recommended for staff and volunteers of immunization clinics (unless contraindicated):

Screening of staff, volunteers and clients for illness/exposure to COVID-19 by the use of signs and active screening (based on provincial / territorial recommendations) before entry into the clinic, either through in-person or telephone questions on arrival. Any online screening done prior to the clinic should be reviewed on entry into the clinic to ensure that there has been no change in health status.

Staff who feel unwell should not attend their shift and should communicate with the Human Resource / Scheduling personnel through pre-arranged methods. Plans should be in place to rapidly find replacements for staff who cannot work due to illness.

Strategies to support physical distancing, such as:

Infection prevention and control (IPC), including:

Mask use by clients:

All clients should wear a mask (cloth mask is sufficient unless there are specific jurisdictional requirements) at all times during the clinic (except for children less than 2 years of age, those who cannot tolerate a mask or those who require removal of the mask for medical attention). If a client attends the clinic without a mask, they should be provided with a disposable mask. If the client cannot wear a mask, options include one or more of the following:

Environmental objects and surfaces:

Food and beverages at the clinic:

Consuming food and beverages at the clinic may increase the risk of COVID-19 transmission as it requires the removal of masks. Any food or beverage provided by the clinic for staff and volunteers should be individually packaged and provided in a manner to avoid staff and volunteers from congregating. If possible staff and volunteers should eat offsite (e.g., outside or in their vehicles) or if needed, they should eat in large, well-ventilated dedicated staff spaces, maintain a distance of at least 2 metres between individuals, and minimize the number of people in the staff room at any one time (i.e., breaks should be spaced out). Before returning to the clinic area, hands should be cleaned, and eye protection and a new medical mask put on.

Communications

Timely, clear and frequent communication with the public and staff is crucial for the successful implementation and delivery of immunization clinic operations. Important considerations in planning clinic communications include identifying the following:

Messages and information can change frequently as new information becomes available. Therefore, communication plans should be flexible and dynamic. Social media channels are an effective way to provide information updates if circumstances change. Where feasible, it is recommended that targeted communication material be prepared in advance and circulated as early as possible before the planned clinic dates.

Public communication (external)

Messages about the pandemic vaccine should be clear, transparent and timely. They should clearly indicate what is known about the vaccines, what is unknown or uncertain, and what is being done to address uncertainties and to monitor safety. Examples of key points to communicate:

In addition to messages for the general public, specific mechanisms should be selected to reach those populations specifically targeted for vaccination at a given point in times (e.g., seniors, long term care facilities, health care providers). Also consider specific communications for health care providers, since even if health care providers are not currently involved in providing immunizations, they are a key source of reliable information for clients making decisions regarding COVID-19 vaccination.

Local emergency services personnel and nearby hospitals should be informed of the dates, times and locations of each clinic, so that medical support can be rapidly available if needed.

Table 5: Examples of materials, medium and format for communication with the public
Materials Medium Format
  • announcements
  • posters/fact sheets
  • pamphlets
  • media releases
  • recorded telephone messages and other recorded messages online
  • radio, television, newspaper, telephone
  • signs, billboards
  • telehealth and public health information lines
  • websites:
    • government
    • dedicated website
  • social media
  • community leaders
  • community organizations
  • community health centres
  • physicians' offices and hospitals
  • pharmacies
  • hospitals
  • food banks, homeless shelters, group homes, long term care homes and retirement homes
  • large and clear font
  • bullet points
  • highlighting important messages and listing important messages first
  • frequently asked questions
  • images/diagrams/infographics
  • plain language
  • culturally relevant and sensitive
  • translated into multiple languages
  • formats for the visually impaired and hearing impaired

Technologies such as social media and instant text messaging make it easier and faster for public frustrations and concerns with immunization clinics to be publicized. These situations should be anticipated and methods to monitor and respond to them should be identified.

For additional tips and facts about communicating, see:

Clinic staff and volunteer communication (internal)

Methods will be needed to efficiently convey new information to clinic staff and volunteers. Communication with staff and volunteers should be clear and timely to support effective clinic operations. Effective communication practices provide staff and volunteers with people to contact and sources to check to receive information, and lines of communication to relay information, feedback and concerns. See Table 6 for examples of strategies to communicate with staff and volunteers.

Table 6: Methods to communicate with staff and volunteers

Examples of methods to communicate with staff and volunteers

  • Regular emails and/or text messages
  • Websites used as a repository for shared information
  • One-on-one relaying of information before the clinic starts
  • Meetings before the clinic opens to the public ('Just in time' training) and debriefs after each shift. If using these approaches, care must be to taken to maintaining physical distancing and wearing masks and eye protection at all times. Shouting should be avoided and meetings should be kept as short as possible.
  • Regular teleconferences or webinars
  • Regular touch base meetings with Clinic Leaders/ Clinic Floaters to ensure consistency of clinic operations, share ideas and problem solve

Data management

It will be important to identify the methods to collect, manage, store and transport data (e.g. paper and/ or electronic) and to establish appropriate systems to support secure data management, based on jurisdictional legislative and policy requirements. Types of data can include:

How client information from the Consent Forms will be captured electronically will need to be determined, including if it will be entered online directly by the client, entered electronically at the clinic by the client or person doing the registration, or entered on paper and then transcribed to a data management system.

Data management systems should easily support the generation of information required for provincial/territorial and/or federal reporting requirements. For the overall campaign, considerations should also be given on how to analyze and report on coverage including numbers vaccinated overall, in the groups targeted for immunization such as those with underlying medical conditions and working in various occupations, and in various sociodemographic groups (age, gender, race) and geographic regions.

Staff training should emphasize the maintenance of privacy and confidentiality and the procedures and policies to respond to any possible breaches. Contingency plans should be in place in case electronic data systems are not working.

Supplies

Non-vaccine clinical supplies

Some clinic supplies will be procured and supplied by the Government of Canada (e.g., syringes, needles, alcohol swabs, bandages, gauze, sharps containers), while other equipment will need to be procured by the province, territory or local jurisdiction or supplied by the immunization site. Appendix 1 offers a suggested list of supplies that can be adapted to jurisdictional needs.

Planning parameters and numbers of people who need to be immunized form the basis for the quantity of supplies needed. Processes and systems will be required to order and receive supplies, monitor inventory and store and pack supplies. Consider a large room where supplies can be stored and organized, with the list of supplies guiding the packing for each clinic. Supplies can be loaded into bins or tubs that are labelled with types of supplies in each one. If operating more than one clinic at a time, consider colour-coding the bins so that the same colored bins go to the same clinic. Additionally processes will be needed transport supplies to each clinic location, to re-supply clinics that remain at the same location over a period of time, and to receive supplies back from clinic sites that are no longer operating. Supplies that remain at the clinic location must be stored securely but be easily accessible to clinic staff. Protocols to replace missing or stolen items on an urgent basis should be developed.

Vaccines: Storage and handling and cold chain maintenance

Special attention will be required for the storage and handling of COVID-19 vaccines, as some COVID-19 vaccines may require storage at ultra-low temperatures (- 80 oC) or freezer temperatures (- 20 oC), while others will required usual + 2 to 8 oC storage, as per manufacturers' specifications. The vaccines requiring storage at ultra-low or freezer temperatures will have specified periods of time where they can be stored at + 2 to 8 oC prior to use. The date and time when these vaccines are put in the refrigerator and when they need to be used by should be marked on the carton, box or paper kept next to or attached to the vial (do not obstruct the vial label with any paper attached to the vial).

If vaccine is being stored at the clinic site overnight, special attention will be required to ensure that this can be done securely. In some clinic settings, equipment may not be available at clinic sites to store vaccine overnight or the location may not be sufficiently secure and therefore arrangements will need to be made to transport vaccines to and from vaccine storage sites, respecting cold chain and transporting requirements for the products and never transporting the vaccine in the trunk of a car. Equipment such as frozen packs, vaccine coolers, insulated bags, dry ice and the personal protective equipment required to manage the dry ice (depending on the product), and thermometers / data loggers will be needed to maintain appropriate cold chain at the clinic site, as well as during transport to and from the clinic.

Protocols will be required for monitoring and recording the vaccine storage temperatures, particularly if the vaccine is being stored in vaccine coolers or insulated bags, instead of in a refrigerator or freezer. Assign a specific staff member (e.g., Clinic Specialized Support, Clinic Floater) to monitor and record vaccine temperatures at specified frequencies, including on arrival and at the end of the clinic and periodically during the clinic, as per jurisdictional requirements.

Vaccines may have specified time frames when they can be kept at room temperature, used once mixed with diluent or adjuvant, used once the vial is punctured and/or when pre-loaded into a syringe. The start time for these time frames should be written down and the paper stuck to or kept right near the product so that the times frames can be closely monitored. The manufacturer may have specific recommendation on what should be marked on the vial. The end time can also be written down; it both times are used, it should be clear which time is the start time and which is the end time. Mixed vaccine vials and pre-loaded syringes that are not being used immediately may need to be stored in an insulated bag or cooler or may be able to be stored at room temperature, based on the manufacturer's recommendations. If stored in an insulated bag or cooler, these should have frozen packs and an appropriate insulating barrier (e.g., bubble wrap, crumpled paper, Styrofoam peanuts) which is positioned so that the vaccine vial or pre-loaded syringes do not touch the frozen packs to prevent freezing the vaccine. If the vaccine remains in the insulated bag for more than an hour, temperature should be monitored and recorded.

Refer to relevant jurisdictional vaccine storage and handling guideline documents or the current National Vaccine Storage and Handling Guidelines for Immunization Providers for information on cold chain management, vaccine storage, temperature monitoring and transportation requirements.

Vaccines stored at ultra-low temperatures (-80 oC) or in a freezer at -20 oC will need to be thawed before use and cannot be refrozen. Manufacturer's instructions should be followed regarding the thawing process in the refrigerator and/or at room temperature. Each vaccine has a limited number of days when they can be maintained at +2 to 8oC before administration. Therefore, sufficient supply to accommodate the anticipated needs of the clinic should be thawed and available at the clinic. The date and time the product was thawed and the date and time which it should be used by should be clearly marked as noted above. Some vaccines may be required to come to room temperature before administering.

A plan should be made to ensure the use of any extra thawed vaccine, which may include using it at a clinic over the next few days, or using it in a congregate living setting or health care provider's office based on current eligibility criteria (assuming is it appropriate to transport the thawed vaccine and it is transported under appropriate cold chain conditions). If thawed vaccine cannot be transported and is approaching the maximum time at refrigerator temperature or the clinic will not be returning to the same site in the near future, consider contingency planning such as a waiting list of people eligible for vaccination who can be called into the clinic on an urgent basis to receive any remaining doses. If that is not possible, consider other approaches to offering the vaccine in the following order: those who are currently eligible; those who are likely to soon become eligible; others as appropriate. It is important not to waste dosages. Decisions that are made to give doses to those who are currently not eligible in order to avoid wastage should be documented.

Non-clinical supplies

Once sites have been selected, it is advisable to identify non-clinical supplies, such as tables, chairs, mats, garbage cans, pylons / stanchions, wheelchairs and electronic equipment that are available on-site for use during clinic activities. This will vary by site. For example, a school may have tables, chairs and mats available for use, while an arena or shopping centre may not, requiring that they be purchased, rented or borrowed. If non-clinical supplies are to be purchased, consider where they will be stored after site closure. Appendix 1 offers a suggested list of electronic, administrative, cleaning and furniture supplies that can be adapted to jurisdictional needs.

Availability and reliability of internet connectivity should also be assessed if that is required for clinic operations, as should locations of power supplies for electronic equipment.

Signage

Clinics should display clear signs with directions to guide clients through clinic stations, so that efficient movement through the immunization process is facilitated. Signs should be clear, in large font and appropriate language, employ features to enhance accessibility and visibility (e.g., high contrast) and where applicable, should use a combination of text and images (e.g. directional arrows). Consider plans and procedures to assist and navigate visually impaired clients. Examples of clinic signs are the following:

Key documents

The following outlines the key documents that may be required in either paper or electronic format. The need for these documents may vary depending on clinic processes. All information sheets and forms for the public should be accessible, clearly written, easy to understand and available in multiple languages based on jurisdictional needs.

All forms that contain personal or personal health information should conform with jurisdictional information collection and privacy requirements.

Clinic operations

Immunization clinic set-up and flow

Clinic setup will vary by site capacity and room layout but nonetheless should have a logical unidirectional flow. As much as possible, it is recommended that a standard clinic layout be used to avoid confusion among rotating staff. An example of how an immunization clinic can be set-up is provided in Figure 1.

Figure 1: Immunization clinic set-up

Figure 1. Immunization clinic set-up
Figure 1 - Text description

The figure depicts a sample clinic setup with unidirectional flow to each of the clinic stations.

  1. Parking Lot:
    • Parking lot is monitored by a parking lot attendee
  2. Entrance:
    • Entrance area is monitored by security
  3. Greeters: Screen for COVID-19 and eligibility of receiving vaccine
    • If not eligible, proceed to designated Exit which is separated from the flow to the rest of the clinic
  4. Registration station
    • Ensures completion of the Consent Form
    • If eligible, proceed to Pre-Immunization Waiting Area

Privacy divider separates Registration station from the rest of the clinic stations

  1. Pre-immunization waiting area: Clients may wait outside or in their vehicles. Inside, a few chairs for seating can be set up spaced widely apart, with room for wheelchairs and strollers. The area is supervised by Client Flow Monitors who can call clients in from their vehicle if waiting outside.
  2. Immunization Area: Separated by a privacy divider for:
    • Vaccine supply
    • Data collection and non-vaccine supplies
  3. Post-immunization Waiting Area
    • Can be done outside or in vehicles. If inside clinic seats should be spaced widely apart.
    • Needs to be supervised by Post-Immunization Waiting Area Monitors who can observe clients inside or outside.
    • For those inside, after the waiting period is over, proceed to Exit #2.
  4. First Aid station: Separated from 7, the Post-Immunization Waiting Area, by a privacy divider

Pre-immunization processes

Pre-scheduling appointments/ pre-registration before attending the clinic

To prevent transmission of COVID-19 at immunization clinics, it will be essential to minimize crowding and ensure physical distancing. Strategies to assist with appropriately spacing clients and minimizing crowding on arrival at the clinic include:

Parking lot

Parking Lot Attendants guide flow and manage the parking lot. To further prevent lines and crowding on arrival at the clinic, consider having clients call or text when they arrive at the clinic and wait in their vehicle or outside until they receive a call or text to enter the clinic. Clients without a cell phone can advise the clinic that they have arrived in person and provide their license number and location of their vehicle, so that staff can notify them when they can proceed to enter the clinic. After receiving their vaccine, there may also be an option for clients to wait in their vehicles for the post-immunization waiting period.

Line-ups

If lining up is required before entering the clinic, clients should wear a mask (unless unable to do so) and maintain physical distancing. Tape on the ground can help indicate places to stand that are at least 2 metres apart, with assistance provided for clients who are blind or partially sighted. The Greeters or other clinic staff (such as the Clinic Floater) should monitor the lines, and provide clients with updates regarding waiting times and answer questions. Appropriate seating and arrangements (such as moving them through the clinic more quickly) should be provided for those clients who cannot tolerate standing in line for long periods (e.g., older clients, people with disabilities, families with young children). If there is a possibility that clients will need to wait outside during the winter or inclement weather, consider options such as tents and heaters.

Clients may show-up at clinics in advance of the start of the clinic. Strategies should be considered to manage this line-up including beginning the clinic earlier / as soon as everything is in place and organized to begin, and having the maximum number of Immunizers available at the start of the clinic.

Greeting and screening

Clients are welcomed to the clinic by the Greeters. For appointment-based clinics, the Greeters determine if the client has an appointment and if the client fits the COVID-19 vaccine eligibility criteria for the particular clinic. Screening for COVID-19 is performed as per the clinic and jurisdiction's screening protocol. Signage with the eligibility criteria and COVID-19 screening questions can assist with these processes. Clients who fail the COVID-19 screening should return for immunization at a later date, as per recommended local public health protocols, and should be advised to seek medical attention as appropriate. If they need to speak with a health care provider at the clinic, this should be done away from others and with the client wearing a mask. Clients who pass the screening and are eligible for immunization are directed to the Registration area, or can be directed to appropriate clinic staff if they have medical questions.

Registration

In the Registration area, staff confirm that the client is able to attend the clinic (e.g., has an appointment if the clinic is appointment-based, and meets the eligibility criteria if the vaccine is only being offered to some populations). If required to attend the clinic, a health card or other form of identification is requested from the client.

Prior to providing informed consent and completing the Consent Form, clients must receive specific information and have the opportunity to ask questions to a regulated health care provider. The specific information is usually provided by having the client read a Vaccine Information SheetSheet (see Section on Key documents). If clients have difficulty reading or understanding the Vaccine Information Sheet or Consent Form, they should be referred to a health care provider (e.g., Clinic Leader, Clinic Floater, Medical Support, Clinic Specialized Support, translator).

To expedite the clinic registration process, it is optimal for the Vaccine Information Sheet to be provided online prior to arriving at the clinic and for the Consent Form to be completed online. Those without online access could be directed to an accessible telephone line where the information required for informed consent can be provided and the questions required for the Consent Form can be obtained; the online form would be completed by the staff on the phone. Alternatively, the Vaccine Information Sheet can be provided in paper form at the clinic and the information for the Consent Form entered electronically by the client or staff at the clinic, or a paper-based Consent Form can be completed with subsequent entry into an electronic system. If electronic documentation methods are used, it is advisable to have hard copies of forms on hand in case of equipment/software failure, connectivity issues or power outages.

Health care providers at the clinic should be consulted if there are concerns about the capacity of the individual to provide informed consent (unaccompanied child or an adult who may not be capable of understanding the information and making an informed choice). Health care providers at the clinic should also be consulted if the client has contraindications to immunization or medical questions.

Attention should be paid to ensure that all personal and personal health information cannot be overheard and that written and electronic information is appropriately safeguarded.

Practical tips for remote and isolated communities
  • Consider having strategies in place to address individuals who present to clinic sites from outside of the community (e.g., individuals from neighbouring communities and off-reserve First Nations).
  • Consider arranging home visits for those unable to attend immunization clinics (e.g., those who are homebound).

Immunization processes

Vaccine preparation

Optimally only one vaccine product (and one dose volume) is provided at each immunization clinic. If more than one vaccine is being provided at a clinic, care must be taken to ensure the client receives the appropriate product, depending on eligibility criteria or if receiving their second dose. Consider dividing the clinic into separate areas for each vaccine if more than one product is being utilized.

Ideally, vaccine should be drawn up for each client at the time of immunization. However, in immunization clinic settings, pre-loading of syringes supports timely and efficient vaccine administration. Pre-loading is particularly applicable when a single vaccine with a single dose is being provided to all clients at the clinic, or less optimally, if distinct areas of the clinic can be allocated to each vaccine, with separate Syringe Pre-Loaders and Immunizers for each area.

To support pre-loading of syringes, the following should be considered:

The area of the clinic where the vaccine mixing and pre-loading is occurring should be located so that clients cannot easily come near that area and cannot see the mixing and pre-loading process.

Mixing with diluent or adjuvant: If a vaccine requires mixing with a diluent or adjuvant, this is optimally done by one Syringe Pre-Loader dedicated to this task. Mixing should be performed using aseptic technique and as per the manufacturer's recommendation and the Canadian Immunization Guide, Vaccine administration practices chapter. The staff member should ensure that once the mixing has occurred, the used diluent or adjuvant bottle is promptly discarded into the sharps container to avoid confusing the various bottles. The bottle with the mixed vaccine should be marked with the date and time of mixing. The mixed product should be used within the manufacturer's recommended timeframe. Care should be taken not to mix more than the number of vials needed to complete the clinic.

Loading of syringes: Drawing the vaccine into the syringe should be done using aseptic technique and as per the manufacturer's recommendation and the Canadian Immunization Guide, Vaccine administration practices chapter. Syringe Pre-Loaders or Immunizers should prepare only the necessary amount of pre-loaded vaccine to support a continuous flow of immunizations, using pre-loaded syringes as soon as possible after pre-loading or as per manufacturer's requirements. If using Syringe Pre-Loaders, Runners deliver pre-loaded syringes from the Syringe Pre-Loaders to the Immunizers and should closely monitor how many pre-loaded syringes are at the Immunizers' stations, especially as the clinic is nearing the end. Runners should communicate with the Syringe Pre-Loaders and Clinic Leads to decide when pre-loading should stop so that no pre-loaded syringes are wasted. Any vial that has been punctured but not completely used during the clinic should be marked with the date and time of first puncture and the date it should be used by, to ensure it is used within the timeframe recommended by the manufacturer. If the vaccine must be used right away, see strategies to avoid wastage.

Vaccine administration

Once registration is complete, clients can proceed to be immunized. They can be directed to the next Immunizer by the person directing client flow. The Immunizer can signal that they are able to see the next client by waving or signaling with a flag. In areas where services are offered in English and French, the Clinic Flow Monitor should direct the client to an Immunizer who speaks their preferred language.

Before vaccine administration: Before vaccine administration the Immunizer should confirm that they have the correct consent form for the client (e.g., by requesting the client's name and date of birth), conduct a pre-immunization assessment, pursuant to relevant jurisdictional professional regulations and policies, which may include determining: the client's health status, the client's understanding of the information provided at registration and ability to provide informed consent, confirmation that there are no contraindications/precautions to immunization (including for the second dose, if there were any serious adverse effects after the first dose that would require assessment before receiving the second dose), and answering any remaining questions the client may have.

Immunizers should be watchful for clients who appear very anxious, pale or sweaty. Clients with these features or a history of fainting when receiving previous immunizations or medical procedures should be immunized lying down on a mat in the First Aid area or in a reclining chair to prevent fainting and injury.

Clients who need privacy to expose their skin can also be taken to the First Aid area or other private space for vaccination.

Immunization: Immunization should be performed as per the manufacturer's recommendation and the Canadian Immunization Guide, Vaccine administration practices chapter, including hand hygiene and appropriate land-marking. Techniques to decrease immunization injection pain are outlined by age in this chapter.

Before administering the vaccine, the Immunizer should visually inspect the vaccine for any discoloration or particulates and ensure that the appropriate dose is in the syringe.

After immunization: After immunization, the safety engineered mechanism on the needle should be activated, and the needle and syringe discarded promptly into the sharps container. Used needles should never be re-capped, and used needles and syringes should never be placed on the immunization table to avoid accidental re-use.

Clients who appear faint, pale, sweaty or weak should be encouraged to remain seated with their head down to prevent fainting and injury. If needed, they can be assisted to lie down on a mat in the First Aid Area. They should only proceed to the Post-Immunization Waiting Area when they have fully recovered.

Documentation: The Immunizer should complete the appropriate documentation in the client's electronic record or on the Consent Form (see Section for the content of the Consent Form). The client should also be provided with a record of their immunization including the brand name of the product received, the date of administration and the name and professional designation of the immunizer.

The client should be advised of the post-immunization waiting period and protocol, and provided with an After-Care Sheet and counselled on its content, including the importance of receiving the second dose of the COVID-19 vaccine and when and where to receive this dose (see Section for content of the After-Care Sheet and counseling information).

Post-immunization waiting period

After immunization, it is recommended that clients be kept under observation in the clinic for at least 15 minutes to monitor for immediate vaccine reactions (i.e., fainting and anaphylaxis). Thirty minutes is safer when there is a specific concern about possible vaccine allergy.

The Post-Immunization Waiting Area could be a potential location where clients may be too close together. Clients should be encouraged to remain at least 2 metres apart at all times in this area with their masks on. Those who cannot wear a mask should be places as far apart from others as possible or should wait outside or in their vehicle (if possible). Chairs should be spaced at least 2 metres apart and the floor should be marked with tape to indicate the position of the chairs. The area should be monitored either by a health care provider, or a volunteers who informs health care providers if assistance is needed. The waiting period also provides an opportunity during which clients can complete an evaluation of their clinic experience (see Appendix 3 for a possible Client Evaluation Form).

The National Advisory Committee on Immunization (NACI) has developed Recommendations on the Duration of the Post-vaccination Observation Period for Influenza Vaccination during the COVID-19 Pandemic. Some of these criteria can be applied to COVID-19 vaccines. While the first NACI criteria related to influenza vaccine was that the individual has been previously vaccinated with that vaccine, for the first dose of COVID-19, no one will have been previously vaccinated. However, it may still be possible to have people wait outside of the clinic or in their vehicles providing that they:

  1. Feel well after the immunization and have no history of fainting after medical procedures.
  2. Are with a responsible adult who can monitor them for 15-30 minutes after immunization.
  3. Remain on the clinic grounds or in the parking lot and have direct access or telephone access to the clinic if they need assistance.
  4. Do not operate a motorized vehicle or other form of transportation (e.g., bicycle, skateboard, rollerblades, scooter) or machinery for a minimum of 15-30 minutes after immunization as advised by the Immunizer.

If clients are waiting outside or in their vehicles after immunization, Post-Immunization Waiting Area staff should circulate in this area so they can respond to issues and concerns that may arise. Clients can be advised to honk their horn if they need assistance.

Management of adverse events

Though very rare, anaphylaxis can occur following immunization and must be managed quickly and appropriately. Fainting, which may or may not be accompanied by brief seizure activity, occurs more commonly, and also requires prompt management. A separate First Aid area of the clinic with mats, and optimally with a privacy divider, should be designated for first aid and the management of fainting and anaphylaxis.

Although specific health care providers at the clinic are designated to manage fainting and anaphylaxis (i.e., Clinic Leaders, Clinic Floaters, Medical Supports), all health care providers should be trained in fainting and anaphylaxis management and have up to date cardio-pulmonary resuscitation (CPR) certifications (if possible based on provincial/territorial/local requirements).

Emergency kits to manage anaphylactic reactions must be readily available and easily accessible by staff at the clinic. Protocols must be in place for maintenance of kits including verifying that all the supplies are still present and none of the medications have expired (epinephrine auto-injectors can have short shelf lives). There should be at least two kits at each clinic location which are located in consistent locations in the clinics (at least one of which is in the First Aid area). A recommended list of items in an anaphylaxis kit is available in the Canadian Immunization Guide: Part 2 - Vaccine Safety. A plan should be in place to rapidly replenish a kit should it be used.

Clinic procedures to manage anaphylaxis or injury after fainting should follow jurisdictional protocols and should include:

Clinic procedures for managing fainting and anaphylaxis along with the medical directive and quick reference card should be readily available in the emergency kits. Juice and snacks should be available for clients who feel weak or faint.

Adverse events following immunizations (AEFI), such as anaphylaxis, are reported as per jurisdictional protocols for AEFI reporting. The AEFI form can be retrieved from respective jurisdictions or the Public Health Agency of Canada (PHAC) website.

Debriefing after serious events at the clinic will offer support to staff and volunteers who were involved and provide opportunities to learn from the event and improve processes.

De-escalation activities

Site closure

Some immunization clinic sites are transient and may be taken down and/or moved frequently, while other sites offer clinics for prolonged periods from the same location. Planning and procedures for site take down and closure should be in place. Staff and volunteers should be made familiar with shutdown procedures and their specific roles. Bins labelled according to the material that should be packed into them helps packing to occur in an organized manner.

Examples of shutdown activities to consider for fixed sites that have remained in the same location are as follows:

Discussion of cleaning protocols with site owners and procedure to identify, report and manage any damage to the facility:

Alternate delivery methods

Although the focus of this document is larger immunization clinics, there are other possible locations and methods to deliver COVID-19 vaccines which include:

Some of the processes outlined in this document may also apply to immunization in these other locations. Specific considerations for outdoor clinics (i.e., walk-up, drive through or parking lot clinics) include:

Evaluation

Evaluations of immunization campaigns and clinics are important as they provide processes to document the response and identify areas for improvement. Ideally, an evaluation plan and evaluation tools should be developed ahead of time, and should include opportunities for staff, volunteers and clients to provide input on their experiences. Evaluation tools should be administered and analyzed throughout the response, in order to make adjustments in real time, not just at the end of the campaign. A variety of evaluative processes can be used, including:

Gathering and analyzing all evaluations should be completed in a timely fashion to ensure that nothing is lost. A written summary report including the processes used in running the clinics, quantitative summary data (e.g., numbers of clinics, numbers vaccinated, numbers of adverse events), evaluation outcomes and lessons learned will support future clinic planning.

Resources

Some resources to help with planning immunization clinics, including drive-in immunization clinics, are as follows:

Some key resources to assist with immunization practices are as follows:

Appendix 1

When determining the clinic supply requirements, consider the estimated number of clients that could be immunized per day (see Section: Immunization Clinic Planning Parameters).

Sample immunization clinic supply list
Item Quantity Cost Supplier Comments
Clinic supplies
Needles and syringes for:
  • mixing with adjuvant/diluent
  • administering vaccines
- - To be supplied by the National Emergency Strategic Stockpile (NESS) for COVID-19 response -
Alcohol swabs - - To be supplied by the NESS for COVID-19 response -
Adhesive bandages - - To be supplied by the NESS for COVID-19 response -
Cotton balls or gauze - - To be supplied by the NESS for COVID-19 response -
Disposable non-latex gloves (assorted sizes) (note: not recommended for immunizing unless skin is not intact) - - - -
Paper cups - - - -
Table covers - - - -
Alcohol-based hand rub (sufficient for each immunizer table, registration desks, entrance, exit, waiting areas) - - - -
Surgical/ medical masks (for staff and if needed, for clients who do not have a mask) - - - -
Face shields - - - -
Tissue boxes - - - -
Disposable gowns - - - -
Paper towels - - - -
Paper bags (lunch size) - - - -
Hypoallergenic tape - - - -
Disinfectant wipes - - - -
Disinfectant solution - - - -
Sharps containers (of appropriate sizes) - - To be supplied by the NESS for COVID-19 response -
Biohazard waste boxes - - - -
Biohazard yellow bags - - - -
Insulated coolers and bags - - - -
Frozen packs - - - -
Maximum-minimum thermometers - - - -
Blood pressure cuff (child and adult) - - - -
Stethoscope - - - -
Adrenalin (epinephrine) 1:1000 or Epi-pens - - - -
Flashlight - - - -
Pediatric pocket mask with one way valve - - - -
Adult pocket mask with one way-valves - - - -
Wheelchair if possible (particularly if the clinic will remain at the same location for a period of time) - - - -
Carry bags/totes - - - -
Numbers for clients in waiting lines - - - -
Table numbers for immunizing stations - - - -
Flags for immunizers to indicate that they are ready for the next client - - - -
Small boxes with no lids for the Runners to carry pre-loaded syringes from the Syringe Pre-loader to the Immunizer - - - -
Water bottles - - - -
Face cloths for clients who feel faint - - - -
Juice boxes for clients who feel faint - - - -
Snacks for clients who feel faint - - - -
Administrative supplies
Pens (quantity will depend on whether a paper based system is being used) - - - -
Clipboard (quantity will depend on whether a paper based system is being used) - - - -
Paper, including paper for signs - - - -
Scissors - - - -
Highlighter - - - -
Transparent tape and masking tape - - - -
Rubber bands - - - -
Stapler and staples - - - -
Batteries - - - -
Replacement ink cartridges - - - -
Large envelopes - - - -
Date stamps - - - -
Identification badges - - - -
Measuring tape to measure distant for furniture - - - -
Tape to stick on floors to space out furniture - - - -
Forms
Vaccine Information Sheet - - - -
Consent Forms - - - -
After-Care Sheet - - - -
Client Immunization Record - - - -
Daily Clinic Summary - - - -
Medical Directive for Obtaining Consent and Administering Vaccine - - - -
Medical Directive to Manage Anaphylaxis, including the Anaphylaxis Medication Quick Reference Dosage Card - - - -
Serious Event Forms - for clinic use - - - -
Incident Reports - - - -
Adverse Event Following Immunization - official provincial/territorial or national AEFI reporting form - - - -
Post-Clinic Evaluation Form for Staff and Volunteers - - - -
Client Evaluation Form - - - -
Time Sheets - - - -
Supply / Re-Supply Lists - - - -
Signage
Maps and directional arrows - - - -
Entrance and exit signs - - - -
Eligibility criteria for the clinic (if indicated) - - - -
COVID-19 screening questions - - - -
Instructions for clients (e.g., contraindications for the vaccine, need to wait 15 minute after immunization, need for masks and hand hygiene) - - - -
Names of stations (e.g., Registration, Immunization, Pre-Immunization Waiting Area, Post-Immunization Waiting Area, First Aid, Washrooms) - - - -
List of other clinics in the area and/or on that day (if needed) - - - -
Other resources
Orientation and training manuals, electronic or laminated with job descriptions - - - -
Incident reports - - - -
Product monographs laminated or online - - - -
Canadian Immunization Guide online or printed copies of relevant sections - - - -
Electronic supplies
Laptops with privacy screens - - - -
Printer (as needed) - - - -
Server (as needed) - - - -
Fax machine (as needed) - - - -
Cellular phones - - - -
Internet access - - - -
Photocopier (as needed) - - - -
Extension cords - - - -
Furniture (as required)
Chairs - - - -
Tables - - - -
Cots/mats for First Aid Area - - - -
Physical barriers for infection prevention and control - - - -
Privacy dividers including for First Aid Area - - - -
Garbage cans - - - -

Modified from the Peterborough County-City Health Unit, Pandemic Influenza Plan - Appendix A Mass Vaccination Plan

Appendix 2: Post-clinic evaluation form for staff and volunteers

Download in Word format the Post-clinic evaluation form.

  1. Date of clinic:
  2. Location of clinic:
  3. What was your role in the immunization clinic?
  4. Was this your first time participating in a larger immunization clinic?
    • Yes
    • No
  5. Was the training you received for immunization clinics adequate? If no, what additional training would you require?
    • Yes
    • No
  6. Did you understand your role and responsibility? If no, what would improve your understanding?
    • Yes
    • No
  7. Was your supervisor accessible when you needed him/her? If no, what could improve accessibility?
    • Yes
    • No
  8. Was the chain of communication clear? If no, what could improve this?
    • Yes
    • No
  9. Were you made aware of any changes and updates in clinic activities? If no, what could improve this?
    • Yes
    • No
  10. Did you feel that the infection prevention and control and occupational health and safety measures were adequate at your clinic? If no, do you have suggestions for improvement?
    • Yes
    • No
  11. How would you rate your clinic site overall?
    • Excellent
    • Good
    • Okay
    • Poor

Explain the factors that contributed to your rating.

  1. What was the greatest personal challenge faced during your time in the immunization clinic?
  2. In your opinion, what were the challenges for your clinic site?
  3. What went well for your site?
  4. Do you have any suggestions to improve the operations of immunization clinics?

Appendix 3: Client evaluation form

Please complete the following evaluation form to guide us on the steps we need to take to improve future immunization clinics.

The comments you provide will be anonymous and only used to identify areas for improvements and practices that worked best. We thank you in advance for taking the time to complete this form.

Download in Word format the Client evaluation form.

  1. Date of clinic
  2. Location of clinic
  3. Gender
    • Male
    • Female
    • Prefer not to say
    • Prefer to self-describe
  4. Age
    • 12-17
    • 18-24
    • 25-29
    • 30-39
    • 40-49
    • 50-59
    • 60-69
    • 70+
  5. City of residence:
  6. Did you receive an immunization today?
    • Yes
    • No
  7. Did you bring anyone else with you today to receive an immunization? Check all that apply.
    • No, just myself
    • Children in my care
    • Spouse
    • Older adult
    • Other (please specify)
  8. How did you hear about the clinic? Check all that apply.
    • Newspaper
    • Website
    • Poster
    • Social media
    • Radio/Televisions
    • Health care provider/ public health official
    • Co-worker/friend/family
    • Other
  9. Did you find that you had enough information about the vaccine before you received it?
    • Yes
    • No
      • If no, are there other things you would like to know about the disease or vaccine?
  10. Was the location and set-up of the clinic site appropriate for your needs?
    • Yes
    • No
      • If no, what would have been a more appropriate location and/or set-up?
  11. What influenced you the most to get your vaccine today? Check all that apply.
    • Concern for my health
    • Concern for the health of others
    • Advised by my health care provider
    • Advised by public health officials
    • Convenient location
    • Convenient time
    • It was free
    • Think it is the right thing to do to control the pandemic
    • Other (please specify)
  12. What was the approximate time you spent waiting to receive your immunization?
  13. The wait time was:
    • Shorter than I expected
    • About the time I expected
    • A bit longer than expected, but reasonable
    • Unreasonably long
  14. Were you satisfied with the care you received at the clinic?
    • Yes
    • No
      • If no, please specify your concerns
  15. Were you satisfied with the precautions to protect you from exposure to COVID-19 at the clinic?
    • Yes
    • No
      • If no, please specify your concerns
  16. What did you like about the clinic?
  17. What did you not like about the clinic?
  18. Do you have any suggestions to improve the clinic?

Appendix 4: Sample of COVID-19 vaccine information sheet for Pfizer/BioNTech COVID-19 vaccine (COVID-19 mRNA vaccine)

Download in Word format the sample COVID-19 vaccine information sheet: Pfizer/BioNTech COVID-19 vaccine (COVID-19 mRNA vaccine).

Please read this information sheet carefully and ensure all your questions have been answered by a health care provider before receiving the vaccine.

The Pfizer / BioNTech vaccine was been authorized for use by Health Canada under an Interim Order on December 9, 2020. An Interim Order allows authorization of the vaccine more rapidly to respond to a public health emergency while following requirements to ensure the health and safety of Canadian.

What is COVID-19?

How does the Pfizer / BioNTech vaccine protect against COVID-19?

Who can and cannot receive the COVID-19 vaccine at this time?

See Table 1 below for information regarding who can and cannot receive the COVID-19 vaccine.

Table 1: People who can and cannot receive the COVID-19 vaccine
Can Receive
the COVID-19 vaccineAppendix 4 - Table 1 - Footnote a
Should Not Routinely Receive
the COVID-19 vaccineAppendix 4 - Table 1 - Footnote b
Cannot Receive
the COVID-19 vaccineAppendix 4 - Table 1 - Footnote c
Age 16 years of age and over 12 to 15 years of age 11 years of age and younger
Feeling unwell with symptoms that could be COVID-19 - - You should not be vaccinated if you have any symptoms that could be due to COVID-19 so that you do not spread infection to others.
Have or had a COVID-19 infection  You can be vaccinated if you are no longer infectious and are feeling better from a COVID-19 infection - You cannot be vaccinated while infectious so that you do not spread infection to others, or if you still feel unwell from a recent COVID-19 infection
Pregnancy  - Currently pregnant or planning to become pregnant before receiving both doses of COVID-19 vaccine -
Breastfeeding - Currently breastfeeding -
Allergy to polyethylene glycol  (PEG)Appendix 4 - Table 1 - Footnote * - - If you have been told you are allergic to polyethylene glycol (PEG)* or have had an allergic reaction from an unknown cause, you should not be vaccinated until it is determined to be safe by an allergist or other health care provider
You had a severe reaction to a previous dose of COVID-19 vaccine, including an allergic reaction - - If you had a serious or allergic reaction to your last COVID-19 vaccine, you should not be vaccinated until it is determined to be safe by an allergist or other health care provider
Medical conditions:
Talk with the health care provider if you are unsure about your medical conditions
-

Problems with your immune system from disease or treatment

Autoimmune conditions

-
You received another vaccine in the past 14 days (not a COVID-19 vaccines) - - If you received another vaccine (not a COVID-19 vaccine) in the past 14 days, it is best to wait 2 weeks from that last vaccine to receive your COVID-19 vaccine

In addition to the information in Table 1, tell the health care provider if:

How is the vaccine administered?

The vaccine is given as a needle in the upper arm and will require two doses given 21 to 28 days apart.

What are the risks of the vaccine?

The study also noted enlarged lymph nodes (swollen glands) in some people which lasted for several days.

What measures have been put in place to safely provide immunizations during COVID-19?

Health care providers are being very careful to prevent the spread of COVID-19 when offering immunizations. Examples of extra safety measures include the following:

What should you do before coming to the clinic?

What should you do after receiving the vaccine?

When should I return for my second dose?

If this is your first dose of the COVID-19 vaccine, be sure to return for your second dose in 21 to 28 days. This is very important to ensure the vaccine works well. You may be asked to book an appointment to receive the next dose. Bring your immunization record with you when you come for your next dose.

If you have any questions, please speak with the person providing the vaccine or contact: Insert contact information

Appendix 5: Sample of consent form for Pfizer/BioNTech COVID-19 vaccine (COVID-19 mRNA vaccine) 

Download in Word format the sample consent form: Pfizer/BioNTech COVID-19 vaccine (COVID-19 mRNA vaccine).

* Polyethylene glycol (PEG) can rarely cause allergic reactions and is found in products such as medications, bowel preparation products for colonoscopy, laxatives, cough syrups, cosmetics, skin creams, medical products used on the skin and during operations, toothpaste, contact lenses and contact lens solution. PEG can also be found in foods or drinks, but is not known to cause allergic reactions from foods or drinks.

I have read (or it has been read to me) and I understand the "COVID-19 Vaccine Information Sheet - Pfizer/BioNTech COVID-19 Vaccine (COVID-19 mRNA Vaccine)". I have had the opportunity to ask questions and to have them answered to my satisfaction. I consent to the receiving the vaccine.

I confirm that I am the parent / legal guardian or substitute decision maker.

See below for additional questions

Additional questions to help understand the populations receiving the COVID-19 vaccine

  1. Race / ethnicity: Please check the applicable boxes

    This information is being requested to help ensure that the vaccine is being provided in a way that is available to everyone who would like to receive it.

    • Black (e.g. African, Afro-Caribbean, African Canadian descent)
    • East/Southeast Asian (e.g. Chinese, Korean, Japanese, Taiwanese descent or Filipino, Vietnamese, Cambodian, Thai, Indonesian, other Southeast Asian descent)
    • Indigenous (e.g. First Nations, Inuk/Inuit, Métis descent)
    • Latino (e.g. Latin American, Hispanic descent)
    • Middle Eastern (e.g. Arab, Persian, West Asian descent - i.e. Afghan, Egyptian, Iranian, Lebanese, Turkish, Kurdish)
    • South Asian (e.g. South Asian descent - i.e. East Indian, Pakistani, Bangladeshi, Sri Lankan, Indo-Caribbean)
    • White (e.g. European descent)
    • Other, specify:
    • Prefer not to answer
    • Unknown
    If Indigenous, indicate which Indigenous identity:
    • First Nations
    • Métis (includes member of a Métis organization or Settlement)
    • Inuk/Inuit
    • Other Indigenous, specify:
    • Prefer not to answer
    • Unknown

    Do you reside in a First Nations Community (on reserve or Crown land) or Inuit Community?

    • Yes
    • No
    • Prefer not to answer
    • Unknown
  2. Do you have any underlying medical conditions (heart disease, lung disease, cancer, high blood pressure, diabetes, problems with your immune system, taking medication that affect your immune system, kidney disease, liver disease)?
    • Yes
    • No
    • Not certain
    • Prefer not to say
  3. Do you live in a group living setting, such as long term care facility, group home, shelter?
    • Yes
    • No
    • Not certain
    • Prefer not to say
  4. What is your occupation? 

    This information is being requested to help determine if the vaccine is being made available to people whose jobs put them at risk for becoming infected with COVID-19.

    • Management occupations
    • Business, finance and administration occupations
    • Natural and applied sciences and related occupations
    • Health occupations
    • Occupations in education, law and social, community and government services
    • Occupations in art, culture, recreation and sport
    • Sales and service occupations
    • Trades, transport and equipment operators and related occupations
    • Natural resources, agriculture and related production occupations
    • Occupations in manufacturing and utilities
    • Other, please specify
    • Prefer not to say
For clinic use only
Vaccine Dose Lot number Expiry date Site and route Time given Date given
month/day/year
Given by
name and designation
Pfizer/BioNTech COVID-19 Vaccine
(COVID-19 mRNA Vaccine)
0.3 ml - - - - - -

Comments: 

Any legal notice required including with regard to confidentiality of the information.

Appendix 6: Sample of COVID-19 vaccine after care sheet for Pfizer/BioNTech COVID-19 vaccine (COVID-19 mRNA vaccine)

Download in Word format the sample COVID-19 vaccine after care sheet: Pfizer/BioNTech COVID-19 vaccine (COVID-19 mRNA vaccine).

What should I do right after receiving the vaccine?

What should I expect in the next few days?

Any serious side effects after vaccination should be reported to your local public health department.

When should I return for my second dose of vaccine?

Things to remember

Immunization Record

Record for Pfizer / BioNTech COVID-19 Vaccine (COVID-19 mRNA vaccine) (0.3 ml)
Dose  # Date
month/day/year
Lot number Site
Right / Left
Give by
name and professional designation
1 - - - -
2 - - - -
Report a problem or mistake on this page
Please select all that apply:

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