COVID Vaccine Survey for Age 65+ and/or 16-64 with Underlying Medical Condition

COVID Vaccine Survey for Age 65+ and/or 16-64 with Underlying Medical Condition

We are sharing this information as it was provided by the Population Health Coordinator of our regional Rappahannock Rapidan Health District, part of the Virginia Department of Health. 

Governor Northam identified which essential workers will be receiving the vaccine in Phase 1B and Phase 1C. When Phase 1B is launched, it will include frontline essential workers, such K-12 teachers and staff, grocery store workers, migrant farmworkers, corrections facility employees and people who are incarcerated, and those working or living in homeless shelters. Additionally, people over the age of 65 and/or those who have underlying condition(s) will be vaccinated in this stage.

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Phase 1C, which is expected to launch in late spring, encompasses other essential workers, those age 65 and up, and any one 16-65 with underlying medical conditions.

PHASE 1B Vaccine Survey for Individuals

If you are age 65 + AND/OR 16-64 WITH UNDERLYING MEDICAL CONDITION (must be 18 or older to receive a Moderna vaccine) living in the Rappahannock-Rapidan Health District OR are living/coordinating services for those in a correctional facility, homeless shelter, or migrant labor camp and have a FIRM commitment to be vaccinated against COVID-19, please complete this survey:  to be placed on our vaccination list.

This form is only to notify the Health Department of your specific demographics, It does not automatically schedule a vaccination appointment.

PHASE 1B Vaccine Survey for Essential Workers

If you are a business owner/manager who employs essential workers as defined as those directly involved in public-facing, face-to-face interactions (see list below) in the Rappahannock-Rapidan Health District (Culpeper, Fauquier, Madison, Orange, or Rappahannock) please complete this survey:  to be placed on our list of employers requesting COVID-19 vaccinations for their staff.

This list includes categories of essential agencies that the CDC and VDH have considered for vaccination plans.  This is NOT a complete nor final list.  This survey does NOT guarantee vaccination for your staff.

  • Police, Fire, Hazmat
  • Corrections and homeless shelter workers
  • Childcare/K-12 Teachers/Staff
  • Food and Agriculture (Food Packaging and Distribution)
  • Manufacturing
  • Grocery Store Workers
  • Public Transportation Workers
  • Mail carriers (USPS and private)
  • 911 Emergency Communications Center

Please DO NOT fill out more than one survey. We will be in touch when more information is available.

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