Proof of Vaccination

Disclaimer

Your personal health information is being collected and stored securely by the Cornwall Community Hospital using physical, technological, and administrative controls. By uploading proof of vaccination, you are consenting to provide this information to the Cornwall Community Hospital for use in identifying your vaccination status.

You are not required to upload your proof of vaccination if: you have been fully vaccinated and have provided consent or proof to the Occupational Health and Safety department; if you are partially vaccinated and have provided proof to the Occupational Health and Safety department.


COVID-19 Vaccination Attestation

Please provide a First Name.
Please provide a Last Name.
Please provide a Date of Birth.
Please provide a Role.
Please provide a Contractor/Vendor Name.
(file types: .jpg, .png, .pdf, .docx, .doc)
Please provide proof of vaccination.