Vaccine Compliance

"*" indicates required fields

Participant details

Name*

First Last

Phone*

Date of birth*

Email*

Employee type*

Vaccination details

Compliance status*

Fully vaccinated

Awaiting second dose

Valid medical exemption

Not vaccinated and does not hold a valid medical exemption

Dose 1 date

Dose 2 date

File upload

Max. file size: 200 MB.

Please upload your proof of vaccination or a valid medical exemption.

Privacy statement and consent

Aspen Corporate Health (ACH) is committed to your privacy and will handle any information you provide to us in this survey in accordance with the Australian Privacy Principles (APPs) and the Privacy Act (Cth). ACH, on behalf of CSIRO’s Marine National Facility (MNF), is collecting this data in order to assess your medical clearance and to provide better support to you in the area of physical, mental health and wellbeing onboard the Marine National Facility. ACH will only disclose a survey response as required or authorised by law. A survey result may be discretely shared with the MNF should there be an issue with medical clearance.