Offline forms

You should capture vaccination events at the point of care. But if your clinic experiences WiFi or connection issues you can use a paper version of the patient vaccination record.

Note: We will update this paper form when related changes occur within the tool. Make sure you are using the most up-to-date version!

There are two paper forms to cater to the different vaccination clinic operating models.

Standard offline form
standard offline form

Use this form for clinics where the vaccinator screens and vaccinates a patient. It includes space for the vaccinator to add their name, signature and professional registration number.

Standard offline form

Updated: 16/06/2021

Clinical assessor and vaccinator offline form
form split with screener and vaccinator signatures

Use this form for clinics that are operating with the clinical assessor (screening) and vaccinator (vaccinating) model. It includes space for both the clinical assessor and vaccinator to add their name, signature and professional registration number (if appropriate).

Clinical assessor and vaccinator offline form

Updated: 16/06/2021