Offline forms

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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 four 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: 26/04/2022

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: 26/04/2022

Standard co-administration offline form - COVID 19 and Flu
Standard co-administration offline form

Use this form in COVID 19 and Flu co-administration 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 co-administration offline form - COVID19 and Flu

Updated: 26/04/2022

Clinical assessor and vaccinator co-administration offline form - COVID 19 and Flu
co-administration form split with screener and vaccinator signatures

Use this form for COVID 19 and Flu co-administration 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 co-administration offline form - COVID 19 and Flu

Updated: 26/04/2022