This Form is Only For Uploading Your Proof of Vaccination Status For Fully Vaccinated Individuals

Fully Vaccinated means the employer has documentation showing that the person received, at least 14 days prior, either the second dose in a two-dose COVID-19 vaccine series or a single-dose COVID-19 vaccine. Vaccines must be FDA or WHO approved or have an emergency use authorization (EUA) from the FDA.

If you are in the vaccination process, but are not yet fully vaccinated, please return to this form to upload your information when you are fully vaccinated.

If you are an affiliate or visitor and do not intend to come to any LBNL site in the next year, you do not need to complete this form or take any other action. You may wish to inform your host about your intention not to visit the LBNL site.

If you are an affiliate or visitor who is not vaccinated and you intend to visit the site, please contact Health Services by telephone only at 510-486-6266

If you are an affiliate or visitor who has been fully vaccinated and needs to upload proof of vaccination, please continue below.

The University of California recommends that individuals working at UC locations, except those who have had a severe allergic reaction to a previous dose of the COVID-19 vaccine or to any of its components, receive a vaccination to protect against COVID-19 disease.

UC Policy: SARS-CoV-2 Vaccination Program

I acknowledge that I am aware of the following facts:

• COVID-19 is a serious disease, and has killed hundreds of thousands of people in the US, and tens of thousands of people in California

• COVID-19 vaccine is recommended for me and other workers to protect our staff, affiliates, and guests from COVID-19, its complications, and death

• If I contract COVID-19, I can shed the virus for several days even before any symptoms appear. During the time I shed the virus, I can transmit it to others

• If I become infected with SARS-CoV-2, even if my symptoms are mild or nonexistent, I can spread the disease to others. Symptoms that are mild or non-existent in me can cause serious illness and death in others

• Contracting COVID-19 could have life-threatening consequences for my health and the health of everyone with whom I have contact, including my coworkers or peers

IMPORTANT:

The Laboratory is collecting vaccination records in compliance with University of California Policy. They will be maintained as University proprietary records in the Laboratory’s Occupational Health Record System (OHR System). They will only be used to fulfill our obligations and to help us keep our community safe. The OHR system is used in connection with the Laboratory's Health Services clinic operations and is designed to protect the privacy of employee health information. Access to your vaccination records will be restricted to authorized Health Services staff only and records will not be accessible by line management (such as your supervisor, management, or sponsor). Once your records have been uploaded, you will be notified of which set of COVID-19 safety controls you must follow when working at a Berkeley Lab worksite. Management, supervisors, and those responsible for implementing controls, will only have access to the COVID controls you must follow. If you decline to disclose your vaccination status, or if you decline the vaccine under an approved exception, you will be required to continue observing and complying with Laboratory and University policies regarding use of protective equipment, maintaining social distancing, and other controls.

Select "Browse files", select your file, then click "Upload"

You will see a confirmation page when you complete your upload.

By uploading your proof of vaccination below, you consent to the use of your information by the University of California as described above.