Vendor and Contractor Vaccine Attestation

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Vendor and Contractor Vaccine Attestation

Thank you for helping us keep our community healthy. Please fill out the form below in its entirety to submit your attestation of vaccine status. 

 
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By executing this attestation statement I am acknowledging that, if I am attesting on behalf of an organization, that I have the authority to bind my organization, and further, whether I am attesting individually or on behalf of an organization, that I understand that Centra Health, Inc., and its subsidiaries and affiliates (collectively “Centra”), require evidence that all employees, vendors, contractors, volunteers, students, instructors, and medical staff coming to a facility owned or operated by Centra are vaccinated against SARS-CoV-2 (“COVID-19”), unless they have an approved exemption. Accordingly, I am attesting that after November 1, 2021, that I have, if I am attesting on behalf of myself, individually, or that anyone my organization sends to a facility owned or operated by Centra has, if I am attesting on behalf of an organization, either: 1. Been fully vaccinated with a COVID-19 vaccine that has, at a minimum, Emergency Use Authorization by the FDA, or 2. Has been approved for a medical or religious exemption. Medical or religious exemptions are determined by the individual or the organization, as applicable, not Centra. I acknowledge, on behalf of myself, individually, or my organization, as applicable, that proof of vaccination or exemption must be furnished to Centra within twenty-four (24) hours of request by Centra, or such shorter period of time as may be required by surveyors, regulators, or other government entities. I acknowledge, on behalf of myself, individually, or my organization, as applicable, that anyone receiving an exemption must check with the applicable Centra point of contact before entering any Centra facility to review current rules and required mitigation measures applicable to exempted individuals (e.g., COVID testing, additional personal protective equipment, etc.).
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