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    Annexures 1 & 2

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    This document is an employment certificate template for frontline workers (FLWs) and healthcare workers (HCWs) aged 18-44 to receive the COVID-19 vaccine. It requires information about the employee such as their ID details, name, gender, date of birth, and workplace details including the name and address of the health facility. The employee and an authorized official must sign and date the certificate to confirm the employee's eligibility. Annexure 2 lists eligible HCWs and FLWs for vaccination according to India's COVID-19 Vaccine Operational Guidelines.

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    Annexures 1 & 2

    Uploaded by

    cool_sp
    1K views2 pages
    This document is an employment certificate template for frontline workers (FLWs) and healthcare workers (HCWs) aged 18-44 to receive the COVID-19 vaccine. It requires information about the employee such as their ID details, name, gender, date of birth, and workplace details including the name and address of the health facility. The employee and an authorized official must sign and date the certificate to confirm the employee's eligibility. Annexure 2 lists eligible HCWs and FLWs for vaccination according to India's COVID-19 Vaccine Operational Guidelines.

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    This document is an employment certificate template for frontline workers (FLWs) and healthcare workers (HCWs) aged 18-44 to receive the COVID-19 vaccine. It requires information about the employee such as their ID details, name, gender, date of birth, and workplace details including the name and address of the health facility. The employee and an authorized official must sign and date the certificate to confirm the employee's eligibility. Annexure 2 lists eligible HCWs and FLWs for vaccination according to India's COVID-19 Vaccine Operational Guidelines.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    1K views2 pages

    Annexures 1 & 2

    Uploaded by

    cool_sp
    This document is an employment certificate template for frontline workers (FLWs) and healthcare workers (HCWs) aged 18-44 to receive the COVID-19 vaccine. It requires information about the employee such as their ID details, name, gender, date of birth, and workplace details including the name and address of the health facility. The employee and an authorized official must sign and date the certificate to confirm the employee's eligibility. Annexure 2 lists eligible HCWs and FLWs for vaccination according to India's COVID-19 Vaccine Operational Guidelines.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Annexure 1: Employment certificate for the purpose of COVID vaccination

    (For FLWs/HCWs aged 18 years to 44 years)


    (Ref. D.O. No. 1940407/2020/Imm., Dated, 4th April 2021)

    Details of Employee:

    1. Category of employee : HCW- Central/State/Private


    FLW

    2. ID type proposed to be used for vaccination :


    PAN/Passport/Aadhar/Driving License/
    Voter ID/NPR Smart Card/
    3. ID Card Number : ______________________________
    4. Name (as recorded in the selected ID card) : ______________________________
    5. Gender : Male/Female/Other
    6. Year of birth (as recorded in selected ID card) : ______________________________

    Details of the workplace:

    1. Name of the Health Facility/ Office : _______________________________


    2. Ministry/Department : _______________________________
    3. Full address : _______________________________
    _______________________________
    Pin Code : _______________________________

    It is hereby certified that the details given hereinabove are correct as per the
    employment records of Dr./Shri/Smt. _____________________________.

    Signature of Employee Signature of authorized official


    Designation: ___________ Name: _________________________
    Mobile Number: ________________ Designation: __________________
    Mobile number: ______________

    Date of issuing: _______________


    Place of issue : _______________ (Office Seal)
    Annexure 2: Eligible HCWs and FLWs as per Operational Guidelines (28/12/2020)
    (Web link : https://www.mohfw.gov.in/pdf/COVID19VaccineOG111Chapter16.pdf)

    Note: PRI official engaged in COVID-19 containment, surveillance & associated activities, RPF, Polling
    officials (from Tamil Nadu, Puducherry, West Bengal, Assam & Kerala) and staff on Kumbh Mela Duty
    have been included in FLW subsequently.

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