Forms
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Request for Medical Exemption from Vaccinations
PDF [205KB]
Form 139-M
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Request for Religious Exemption from Vaccinations
PDF [164KB]
Form 139-R
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Non-Viable Vaccine Returns
PDF [62KB]
Providers: Should this vaccine be returned or disposed? Check this document.
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Vaccine Wastage and Disposed Form
Form 132. Please complete this Wastage and Disposed form for any vaccine that is wasted and disposed of by vaccine providers.
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Vaccine Return Form
Form 131. Please complete this Vaccine Return Form for any vaccine eligible for return by vaccine providers.
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Vaccine Borrowing Report
PDF [170KB]
Form 1122
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Temperature Log for Refrigerator
PDF [297KB]
Form 670
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Temperature Log for Freezer
PDF [252KB]
Form 670F
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