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Annexures 1 & 2

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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4K views2 pages

Annexures 1 & 2

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.

Uploaded by

cool_sp
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
  • Employment Certificate Details: Provides a template for an employment certificate intended for COVID vaccination purposes, detailing employee information and workplace certification.
  • Eligible Healthcare Workers: Illustrates categories of workers eligible for COVID-19 vaccinations and explains frontline worker classifications with diagrams.

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.

Annexure 1: Employment certificate for the purpose of COVID vaccination (For FLWs/HCWs aged 18 years to 44 years) (Ref. D.
Annexure 2: Eligible HCWs and FLWs as per Operational Guidelines (28/12/2020) (Web link : https://www.mohfw.gov.in/pdf/COVID

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