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COVID-19 Vaccination Pre-Registration for Arlington Essential Worker Employers

Pre-Registration

Arlington County Public Health Division is pre-registering Arlington employers of essential workers in the Virginia Department of Health priority groups 1A, 1B and 1C that are interested in obtaining a COVID-19 vaccine. 

This form is for EMPLOYERS from priority groups 1A, 1B, and 1C to register all of their employees.

If you are an individual employee of an essential organization, please tell your supervisor to arrange for one person to register on behalf of all staff via this link https://www.arlingtonva.us/covid-19/vaccines/. Your employer will then be given instructions on when and how to upload all employees for vaccine appointments.
1. Which sector(s) of essential workers listed below are part your organization?: *This question is required.
If you don't know the exact number, enter the approximate number of essential workers you will be registering.
4. Provide the contact information of the point of contact from your organization to coordinate vaccination for all employees: *This question is required.We will coordinate with this individual to register eligible essential worker personnel.