The Centers for Disease Control & Prevention (the “CDC”) recommends that all adults receive an updated COVID-19 vaccine. The Massachusetts Department of Health requires that all healthcare personnel who care for residents in long-term care facilities be vaccinated for COVID-19, but permits healthcare personnel in lieu of receiving vaccinations to execute a declination certifying that the individual has received information about the risks and benefits of the COVID-19 and has chosen not to receive the vaccination(s).
I acknowledge that I am aware of the following facts:
- I have received the vaccine information sheets on the COVID-19 and I understand the risks and benefits of the COVID-19 vaccine.
- If I become infected with COVID-19, even if my symptoms are mild or non-existent, I can spread COVID-19 to others. Symptoms that are mild or non-existent in me may cause serious illness and death in others.
- I understand that the strains of virus that cause COVID-19 change often and even if they do not change, my immunity declines over time.
- The consequences of my declination to be vaccinated could have serious or life-threatening consequences for my health and the health of everyone with whom I have contact, including my coworkers and all patients/residents of long-term healthcare facility.
- By declining vaccination, I will be subject to long-term care facilities’ mitigation measures to prevent viral infection and transmission.