Report your COVID-19 Vaccination Status

The information requested on this form is collected for the purpose of notifying WRH Employee Health of your COVID-19 vaccination status and will be kept private and confidential.

Questions or issues submitting this form? Please email

Download a digital copy of your COVID-19 vaccination receipt here.


Demographic Information

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Do you have a WRH Employee ID? (from your WRH pay cheque.)



COVID-19 Vaccine Status

This information will be reviewed by Employee Health and kept private and confidential.

Please choose ONLY ONE option below to indicate details from your COVID Vaccine status

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Number of COVID-19 vaccine doses received

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Delete Current File



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