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Form

Self-declaration form and checklist for coronavirus vaccination

Published Updated

Here is a self-declaration form and checklist that can be used for coronavirus vaccination. This is a voluntary tool for structuring the collection of necessary information in connection with coronavirus vaccination. The content is mainly the same, you can choose which version you use depending on needs.

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Self-declaration form before vaccination

This can be filled in by the person to be vaccinated, brought on the vaccination day where the vaccinator can use it as documentation until electronic registration is possible.
 
2 pages, more comprehensive information on the back.

 

Checklist before vaccination

This can be distributed orally or in writing.
 
2 pages, more comprehensive information on the back.

16.03.2021: Updated versions 

 


Nedlastbar

    Om printed publication

  • Year: Dec 2020, Feb 2021, Mar 2021
  • By: Norwegian Institute of Public Health