UCLA Health System
2009-2010 Flu Program Education, Survey and Declination

Completion of this online form is required for all UCLA Hospital System staff.
Please complete after you have received the influenza vaccine or decided to decline the influenza vaccine.


Please enter your 9-digit employee id number:
Note:
Please enter ID without space or dashes for example: 123456789
If you do not remember your ID number please check your ID Badge

The Centers for Disease Control and Prevention (CDC) recommends annual influenza immunization for health care workers. All healthcare workers are strongly encouraged to be vaccinated against influenza to protect you, our patients, and fellow co-workers.  

Annual flu vaccinations are offered at no cost to UCLA Health Care Workers.

Please read the following important links to learn about the diagnosis, transmission, treatment, non-vaccine control measures, and potential impact of influenza.

INACTIVATED INFLUENZA VACCINE: What You Need to Know 2009-2010

Influenza Symptoms

Stopping the Spread of Germs at Work

What to Do If You Get Sick with Flu

Additional important information about the flu and it's prevention can be found at http://www.cdc.gov/flu.