COVID-19 Vaccine Interest Pulse Survey
NOTE TO EMPLOYER: Pulse surveys are a tool for obtaining feedback on a specific topic, such as employees’ interest in receiving the COVID-19 vaccine. The survey should be short so you can quickly summarize the results and take action, if necessary. If available, utilizing automated survey technology is an effective and efficient way to administer the survey.
Before administering a pulse survey, ask yourself the following questions:
Below are sample questions for consideration. They are intended to be modified to fit the purposes described above, specific to your organization.
In the months ahead, vaccines for COVID-19 will start to become more readily available to the general population. We are requesting all employees complete this quick “pulse” survey, so we can gain a better understanding of employee interest in receiving the vaccine over the next few months. The results from this survey will allow our organization to make informed updates to our COVID-19 response plan.
Your response to this survey is anonymous and will only be viewed in aggregate form.
Indicate your work location: ______________________
Indicate your department: ________________________
Indicate your current shift: ________________________
When eligible, what is your plan for receiving the COVID-19 vaccine?
Before administering a pulse survey, ask yourself the following questions:
- What do we want to measure/know?
- Why do we want to measure it/know it?
- What do we plan to do with the data?
- How will we communicate our organization’s approach to COVID-19 vaccination, and information about vaccines in general?
Below are sample questions for consideration. They are intended to be modified to fit the purposes described above, specific to your organization.
In the months ahead, vaccines for COVID-19 will start to become more readily available to the general population. We are requesting all employees complete this quick “pulse” survey, so we can gain a better understanding of employee interest in receiving the vaccine over the next few months. The results from this survey will allow our organization to make informed updates to our COVID-19 response plan.
Your response to this survey is anonymous and will only be viewed in aggregate form.
Indicate your work location: ______________________
Indicate your department: ________________________
Indicate your current shift: ________________________
When eligible, what is your plan for receiving the COVID-19 vaccine?
- I will be getting the vaccine
- I will not be getting the vaccine
- I am undecided at this time
- Provide education and awareness about the risks and benefits of vaccines
- Provide time-off from work to receive the vaccine
- Provide an incentive through our wellness program
- Consider an on-site clinic to administer the vaccine
- Other: Please describe