COVID Vaccination Self-Reporting Form

Please use the form below to submit your COVID vaccination documentation.

Important

• Before submitting the form, please review all fields to ensure you entered your information correctly. If there are errors in your name, email address, employee ID or date of birth, we may not be able to process your submission.
• When uploading documentation, acceptable file formats are PDF, PNG, JPG and .GIF. Please be sure the image is readable. If the image is not readable, your request will not be approved.
• You can find your UMMS employee ID number on your pay stub. You can also ask your manager. In most cases, your employee number is not the same as your badge number.

Note: If you are using Internet Explorer, the form below may not appear. Please use Google Chrome, Microsoft Edge, Safari or Firefox to access the form. Learn how to find other browsers on your computer.