Staffing Form
If you need to cancel or change your sign up slot, email
covidvaccineclinicstaffing@centrahealth.com
Do NOT forget to close your browser after signing up!
Please complete this form to sign up to work at a Centra COVID-19 vaccine clinic. Please exit the form if you have reached it in error.
Projected last day for vaccine clinic to be open is Friday 2/26/2021, closing at 5 PM
COVID-19 Vaccine Clinic Staffing Form
Name (and Title):
Phone Number:
Email Address:
Can you administer medication?
Yes
No
Can you document medication in Centra’s Cerner EMR?
Yes
No
Select one of the following:
I am clinical
I am non-clinical
Time Selection Section
Date:
Location:
LGH
Role:
Each time you select a role above, click the button to update the time slots!!
Select Role, then click button to find available time slots ===>
Time Slot:
No Time Slots Available
Sign Up!
Date
Location
Role
Time