Which ethical principle is demonstrated when a nurse is providing influenza vaccinations at a community senior center?

General questions

Why do I need to be vaccinated?

Transmission of vaccine preventable diseases (VPDs) and tuberculosis (TB) in healthcare settings has the potential to cause serious illness and avoidable deaths in workers, patients and other users of NSW Health agencies as well as others in the community. Under the Work Health and Safety Act 2011, risks must be eliminated or minimised through controls. NSW Health therefore has a duty of care and a responsibility under work health and safety legislation to control and minimise risks.

How do vaccines work?

Vaccines work by triggering the immune system to fight certain infections. If a vaccinated person comes into contact with these infections, their immune system is able to respond more effectively, preventing the disease developing or greatly reducing its severity.

How safe are vaccines?

Vaccines used in Australia are safe and must pass strict safety testing before being approved by the Therapeutic Goods Administration (TGA). In addition, the TGA monitors the safety of vaccines once they are in use. More information about vaccine safety is available from the Australian Government Department of Health.

What are the side effects of vaccination?

While there is a risk of adverse events following immunisation (AEFI) with any vaccine, most are mild and resolve quickly. The most common side effect is pain, swelling or redness at the injection site. Serious side effects are extremely rare. If you are concerned about any side effects after vaccination you should contact your local doctor who should also make a report to the local public health unit. Anaphylaxis is a severe allergic reaction that occurs very rarely after vaccination, however it is readily managed by trained nurses or doctors.

What evidence of my vaccinations do I need to provide?

Workers employed in Category A positions must provide the documentation evidence as specified in Appendix 1 of the policy directive Evidence of Protection.

Category B workers are required to provide evidence of COVID-19 vaccinations as specified in Appendix 1 of the policy directive Evidence of Protection.

Who can complete the Vaccination Record Card for Category A Workers and Students?

The Vaccination Record Card for Category A Workers and Students must be completed by an appropriately trained assessor. This is a person who is considered by the health agency or education provider as having the appropriate skills to competently assess a worker’s compliancy status. This may be a doctor, paramedic, registered nurse (RN) or enrolled nurse (EN) who has training on this policy directive in the interpretation of immunological test results, vaccination schedules, TB assessment and/or TB screening.

Appropriately trained pharmacists may complete the sections relating to MMR (measles, mumps, rubella), dTpa (diphtheria, tetanus and pertussis) and influenza vaccines.

If I have a medical condition and cannot be vaccinated – what should I do?

Most people with medical conditions can be safely vaccinated. You should discuss your medical condition with your doctor who will assess and provide advice on whether you have a medical contraindication to vaccination. If you have a recognised medical contraindication to vaccination, you will be required to submit evidence to the assessor in your local health district (LHD) or Health Agency to support the application for a temporary or permanent medical contraindication.

Not all vaccines are 100% effective – why do I have to have them?

The overwhelming evidence is that immunisation and the provision of population-wide vaccination programs remain one of the most effective public health measures to protect the community from preventable diseases. While no pharmacologic agent, including vaccines, is 100% effective, vaccination offers the best protection for individuals and for those they come into contact with.

Why can’t my hospital/facility access my vaccination history on the Australian Immunisation Register instead of me having to show my vaccination records?

The Australian Immunisation Register (AIR) was previously known as the Australian Childhood Immunisation Register (ACIR) and was expanded in October 2016 to record vaccinations given to individuals at all stages of life. There is no historical adult vaccination data held on the AIR so vaccination histories are unlikely to be complete at this stage. This will change over time as adult vaccinations are routinely reported to the AIR by immunisation providers. In addition to vaccination records, there are other requirements to demonstrate your compliance that are not available on the AIR, including serology results for hepatitis B protection and the TB checklist.

What if a worker refuses to get vaccinated and screened?

Vaccine preventable diseases can cause serious illnesses, and so NSW Health staff have a responsibility to do everything they can to minimise the risk of disease spreading to their patients. Workers with a medical contraindication to vaccination will not be terminated on the basis of their medical contraindication but will be risk managed as specified in the policy directive.

In the absence of a medical contraindication to vaccination, other alternatives will be explored to minimise the risk of transmission, including re-deployment to low risk areas. Where these alternatives have been exhausted and the risk of transmission cannot be acceptably managed and/or the worker refuses to comply with risk mitigation strategies specified in the policy directive, termination may be appropriate. The NSW Health agency will ensure procedural fairness during this process.

Do new recruits who were previously assessed as compliant as a student need to be reassessed?

Yes. Students who have been assessed as compliant for the purposes of attending clinical placements will be required to undergo assessment and screening in accordance with the policy prior to employment in NSW Health. This information will then be recorded in a state-wide database known as VaxLink and will be available to all LHDs in NSW Health. If you move between facilities or LHDs you won't need to provide the same documents again.

What if a worker who was previously assessed as compliant applies for a new position in the LHD, do they need to be reassessed, especially for varicella (previous verbal history)

Existing workers who have been previously assessed as compliant under the previous policy and apply for a new position in the LHD do not need to be reassessed, including for varicella. If the worker is transferring from a Category B to a Category A position, they must be assessed against the vaccination and screening requirements for Category A workers, including three doses of a TGA approved or recognised COVID-19 vaccine and be vaccinated against influenza annually.

Do agency workers need to be compliant with the policy?

Yes. All agencies that provide workers to NSW Health facilities are obliged to comply with NSW Health policies including the requirements contained in the Occupational assessment, screening and vaccination against specified infectious diseases policy directive. Agencies must ensure that they only provide compliant workers to LHDs. Agency workers must ensure that they have evidence of their compliance available when presenting for shifts to assist with local compliance monitoring processes.

Do part time students need to undertake assessment in their first year of study?

Yes. This is to ensure that any issues with compliance are identified early in the students candidature as those who are non-compliant will not be able to attend their placement which may impact on their course completion. The TB assessment tool should also be submitted in the first year of study.

Does evidence of vaccination require a batch number for it to be accepted?

No. The inclusion of a batch number is desirable where available but is not a requirement for the evidence to be accepted.

Multi-Purpose Services and State Government residential aged care facilities questions

Can a worker in a residential aged care facility who refuses to be vaccinated for influenza refuse to be vaccinated for influenza refuse to wear a mask when there is a legal requirement in place?

If the legal requirement, such as a Public Health Order relating to residential aged care facility workers, requires workers to be vaccinated against influenza, there are no allowances for workers who refuse vaccination, if the vaccine is available to them. You must comply with the legal requirements while it is in place. These requirements have been included in the updated Occupational Assessment, Screening and Vaccination Against Specified Infectious Diseases policy directive to ensure consistency.

Can a person who has not had an influenza vaccination enter a residential aged care facility in an emergency when there is a legal requiremet in place?

In an emergency situation, such as an ambulance call out, or where officers from Fire and Rescue NSW, or NSW Police Force are attending a RACF in an emergency, or where tradespeople are required to attend to urgent repairs, it is considered reasonable for the officers or tradesperson to attend even if they have not been screened or cannot show they have a flu vaccination. If possible, the officers/tradespeople should limit contact with residents and staff. If such personnel are attending the RACF in a non-emergency or non-urgent situations (such as planned attendances), they must have been vaccinated against influenza, if the vaccine is available to them.

Disease specific questions

Hepatitis B

Who can sign the Hepatitis B statutory declaration form?

The vaccination declaration must be signed by an appropriately trained assessor. This may be a doctor, paramedic, registered nurse (RN) or enrolled nurse who has training on this policy directive in the interpretation of immunological test results, vaccination schedules, TB assessment and/or TB screening.

What if the anti-HBs level drops below 10 mIU?

If a worker or student has previously provided evidence of anti-HBs level ≥10 mIU, they are considered to have immunity. No further boosters or serology will be required unless they undergo immunosuppressive therapy or develop an immunosuppressive illness.

Where can I find a history of age-appropriate hepatitis B vaccination schedules?

The National Centre for Immunisation Research and Surveillance (NCIRS) has developed disease specific immunisation history tables that provide a summary of the significant events in vaccination practice in Australia. The hepatitis B immunisation history table provides a history of age-appropriate hepatitis B vaccination schedules.

Varicella

What if a worker present with negative Varicella serology with a history of an age-appropriate dose(s) of varicella-containing vaccine? Do they require an additional dose of varicella vaccine?

No. Routine testing for varicella immunity following vaccination is not recommended because commercially available laboratory tests are not sensitive enough to detect all seroconversions after vaccination. If a person presents with a history of an age-appropriate dose(s) of varicella-containing vaccine (includes workers aged 50 years and over who have received a dose of Zostavax) and negative varicella serology, protection should be assumed irrespective of serological results.

Tuberculosis

Do workers or students who answer yes to any questions in Part B of the Tuberculosis (TB) Assessment Tool need to contact the TB service/chest clinic directly?

No. Workers or students should be referred by the assessor to their local TB service. Workers or students that have previously had TB disease or a positive latent TB infection test need to be assessed by chest x-ray and clinical review. Those entering the health system with health susceptibilities that increase their risk of acquiring TB should be provided with appropriate education, information, advice on their risk; and, an individualised management plan if necessary.

Who should pay for TB screening (TST and/or IGRA) and the chest x-ray?

All new recruits and students are required to meet the cost of initial TB screening (TST or IGRA test). A positive TST or IGRA indicates that follow up is required for active or latent TB, and as per the Principles for the Management of Tuberculosis in NSW (PD2022_007), all investigations for cases, or suspected cases, of TB (active or latent) carried out through admitted patient and non-admitted patient services (including ambulatory care services) in NSW public hospitals and health facilities must be provided free of charge to the patient. This includes chest x-ray following a positive TST or IGRA conducted under the Occupational Assessment, Screening and Vaccination Policy Directive (PD2022_030).

What services can perform a TST that will be accepted for OASV?

Services that can administer and read a TST where the results will be accepted under the OASV policy directive are:

• NSW TB services/chest clinic
• Other Australian state or territory TB clinics
• A collaborating service endorsed by the District or Network TB service (generally restricted to District or Network Staff Health clinics in NSW).

How will pre-migration screening for TB infection affect OASV assessment and screening?

Commencing in July 2022, health students and prospective workers from countries with high TB incidence will be screened for TB infection (using TST or IGRA) as part of their visa medical examination.

Visa applicants settling in NSW who tested positive on this screening will be referred by the Department of Home Affairs to a NSW TB service/chest clinic for follow-up. This referral may be prior to or contemporaneous with OASV assessment.

Workers with a positive TST or IGRA on migration screening should answer 'yes' to having ever had a positive TB skin test (TST) or blood test (IGRA or QuantiFERON TB Gold+ in Part B of the Tuberculosis (TB) Assessment Tool. These workers should be referred to a TB service/chest clinic for clinical review unless the worker provides a summary of TB clinical review from a NSW TB service or the TB clinical review has been attended and updated in Vaxlink.

A negative IGRA on migration screening performed within 3 months of arrival in Australia constitutes a valid TB screening test and these workers do not require further latent TB infection testing.

Re-screening is required where the result of migration screening was:

• a negative IGRA result tested more than 3 months prior to arrival in Australia
• a negative TST (also known as Mantoux test).

Can overseas IGRAs and/or TSTs be used for TB screening requirements?

IGRA tests performed overseas may be accepted for OASV requirements provided they meet the requirements for a valid test. These are:

• No known TB exposure or stay/travel >3 months in a country or countries with high TB incidence since the test was undertaken
• Performed prior to, or at least four weeks after, a live parenteral vaccine
• Results are reported in English.

TSTs conducted overseas are not accepted unless the worker has had a positive TST on migration screening and been referred directly from the Department of Home Affairs to the TB service/chest clinic.

Who can sign off on an IGRA test result?

A laboratory report indicating a negative IGRA result can be signed off as compliant by an authorised immunisation assessor. If the result is positive the worker will need to be referred to a TB Service (Chest Clinic) for a chest x-ray and clinical review.

Where the IGRA result is positive, the worker will need to be referred to a TB service/chest clinic for a chest x-ray and clinical review.

How long does a TB test result remain 'current'?

A validated previous TB test result remains current if the worker has had no possible exposure to TB since that test, i.e.

• no travel to high TB incidence regions for extended periods (greater than three months);
• no known occupational or social exposure to a TB case; or
• known occupational or other TB exposure where screening was completed – the result from the TB contact screening can be used as a 'current' TB test result

For example:

1. a negative TST from 2009 would be current if the worker had no history of travel or known TB exposure since the date of the test
2. a negative IGRA in 2021 would not be current if a worker subsequently returned to their high TB incidence country of origin for an extended period (greater than three months).

Do all students/new recruits who have a positive TST or IGRA need to be referred to a TB Service/chest clinic?

Yes. All new recruits and students who have a positive TST or IGRA need to be referred for a chest x-ray and clinical review at a TB Service/chest clinic. This review is required to assess an individual’s risk of progressing from TB infection to disease, to provide education on disease progression, and consider TB preventative therapy.

In what circumstances are workers granted TB temporary compliance?

To facilitate commencement of employment for a new worker, TB temporary compliance can be granted once a chest X-ray has been undertaken and excludes active TB disease, and the worker has an appointment at a NSW TB service/chest clinic for TB clinical review.

If a worker requires treatment or monitoring supervised by the TB service, TB temporary compliance may be ongoing following TB clinical review. A 'next TB clinical review date' will be provided or entered in Vaxlink. Failure to attend for next TB clinical review may result in TB compliance being revoked.

Influenza

I work night shift and am not at work when they offer the annual flu vaccination during the day shift. What should I do?

Health services are required to make vaccinations available to all workers, including those on a rotating roster. Your staff health unit should provide information for all employees about arrangements to access influenza vaccine.

What do I do if I have a contraindication to the flu vaccine?

Workers employed in Category A positions who cannot be vaccinated, will be required to wear a mask or be redeployed to a non-clinical if practicable and by exception only, during the influenza season (1 June to 30 September annually).

Why do I have to have the flu vaccine when I have heard it doesn’t work?

Infected health care workers can pass the virus on to their patients before they even know they are sick. The most effective way to prevent the flu is by getting vaccinated and adopting additional preventative measures, such as proper hand hygiene and proper sneezing and coughing etiquette (more information is available at Influenza vaccine information for NSW Health workers). Immunisation helps health professionals reduce their risk of contracting influenza and spreading it to their patients. It also reduces the risk of you catching influenza at work and taking it home to your family.

While we know that influenza vaccines do not provide complete protection against influenza (vaccine effectiveness ranges from 30-70% depending on the match with circulating strains and the immune response of the recipient), they remain the best way to prevent influenza and are an important control measure in conjunction with regular hand cleaning and respiratory hygiene. In addition, there is evidence that vaccination also reduces the severity of illness among people who are vaccinated but still get sick.

Can the influenza vaccine give me the flu?

No. It is impossible for the influenza vaccine (the flu shot) to cause ‘the flu’. The vaccines used in Australia contain only part of the influenza virus and cannot cause infection. Common reactions to the flu shot may include soreness, redness and swelling where the vaccine was given. Occasionally other symptoms can include fever, headache and aching muscles that may last one to two days.

Why do unvaccinated workers have to wear a mask?

Wearing a mask, in conjunction with hand and respiratory hygiene, reduces the risk of influenza transmission. However, wearing a mask is still secondary to vaccination in terms of preventing the transmission of influenza.

During a season with pronounced vaccine mismatch, health care workers who have been vaccinated may voluntarily wear a mask to further reduce the risk of transmission. However, this not a requirement of this policy. Influenza seasons with pronounced vaccine mismatch are, fortunately, uncommon.

To protect patients from influenza transmission, both vaccinated and unvaccinated staff members should consistently practice hand and respiratory hygiene and stay at home if they are experiencing influenza-like illness until symptom resolution.

Do students working in Category A positions require the flu vaccine?

Yes. Annual influenza vaccine is strongly recommended for all students and is a requirement for students attending placement in a Category A positions. Students attending placements in Category A positions must receive the current southern hemisphere influenza vaccine registered for use by the TGA.

When do I have to receive the influenza shot?

Influenza vaccine will be available through clinics in your workplace from April and staff in Category A positions should be vaccinated by 1 June annually.

What if I don’t receive it by 1 June?

NSW Health requires all Category A workers and students to comply with the Influenza vaccination requirements of PD2022_030 Occupational Assessment Screening and Vaccination Against Specified Infectious Diseases. Existing workers employed in Category A positions who are non-compliant with the requirement to receive the influenza vaccine by 1 June annually, will be required to comply with all other influenza risk reduction strategies including the use of appropriate personal protective equipment (PPE), during the influenza season and submit Appendix 5 Non-Participation Form of the Policy Directive. For those existing workers employed in Category A positions who do not comply with these requirements and/or who do not have an approved medical contraindication, termination of employment may be appropriate. The NSW Health agency will ensure procedural fairness during this process.

How will this requirement be monitored?

The Chief Executive of the local health district will be reporting annually to NSW Health on compliance with the policy directive.

What if I get vaccinated by my local doctor or nurse?

You should ensure that your doctor or authorised nurse immuniser or authorised pharmacist vaccinator provides you with evidence of influenza vaccination so that a copy can be provided to your staff health clinic.

Can I have the influenza vaccine if I am pregnant or breastfeeding?

Yes. Vaccination is the best protection pregnant women and their newborn babies have against influenza. Influenza infection during pregnancy can lead to premature delivery and severe disease in the mother. Vaccination during pregnancy also reduces the risk of the baby becoming ill with influenza in the early months of life. Pregnant women can have the vaccine at any stage of pregnancy or while breastfeeding.

Can NSW health staff who are aged 65 and over receive the higher immunogenicity vaccine through the staff health program?

Yes. Staff health programs can order this vaccine via the online ordering system. Facilities will need to ensure that it is clearly labelled to distinguish it from the quadrivalent influenza vaccine.

COVID-19

The Public Health (COVID-19 Vaccination of Health Care Workers) Order 2022 expired on 19 June 2022, is COVID-19 vaccination still mandatory for NSW Health workers?

Yes. The revised PD2022_030 Occupational Assessment Screening and Vaccination Against Specified Infectious Diseases requires all NSW Health workers* to have received at least 2 doses of a COVID-19 vaccine to work or be employed in connection with a NSW Health agency including:

• Public Health Organisations (Local Health Districts, Specialty Health Networks (SHNs), Pillars and Affiliated Health Organisations)
• NSW Ministry of Health
• Health Administration Corporation (HAC) entities - being Ambulance Service, NSW Health Pathology, HealthShare, eHealth NSW, Health Protection, Health Infrastructure, and the Health Professionals Councils Authority (HPCA)

*The term "worker" includes persons who are employed in NSW Health whether on a permanent, casual or temporary basis and includes employees, contractors who provide services for or on behalf of NSW Health (including Visiting Medical Officers (VMOs) and agency staff), volunteers, students, researchers and researchers.

Further, and in addition, a determination made by the Health Secretary under section 116A(1) of the Health Services Act 1997 (NSW) on 12 November 2021 (the Determination) requires, as a condition of employment, all NSW Health Service employees to have received at least one dose of a COVID-19 vaccine as at the date of the Determination, and at least 2 doses of a COVID-19 vaccine by 30 November 2021, in order to be employed or remain employed, unless the employee had a valid medical contraindication.

Why are all workers required to have two doses of a COVID-19 vaccine?

The vaccine is highly effective against severe illness, hospitalisation and death, and will keep staff, patients and visitors safe from COVID-19.

NSW Health and other employers are required under Work, Health and Safety laws to implement "all reasonably practical control measures" to ensure the health and safety of staff.

Have the vaccines been properly reviewed by regulatory agencies?

All vaccines available in Australia are approved by the Therapeutic Goods Administration (TGA) for safety, quality, and effectiveness. Vaccine scientists from around the world are working together to ensure that rigorous processes are followed, and no testing or ethical approvals have been bypassed. COVID-19 vaccines must meet the same high standards as any other vaccine approved for use in Australia. For further information about the safety of COVID-19 vaccines visit NCIRS most frequently asked questions about COVID-19 vaccines.

Why do Category A workers require three doses of a COVID-19 vaccine?

As COVID-19 vaccine immunity reduces overtime, Category A workers are required to receive a third dose of a COVID-19 vaccine to reduce the risk of severe COVID-19 infection, illness, and death and prevent transmission of COVID-19 to their patients. A third dose has been shown to increase protection against Omicron compared to two doses, particularly against severe disease and death.

The Australian Technical Advisory Group on Immunisation (ATAGI) recommends a single booster dose of a COVID-19 vaccine, three months after the second dose, for all people aged 16 years and above, to mitigate against waning immunity to SARS-CoV-2 and the emergence of SARS-CoV-2 variants.

What if I have received the Janssen vaccine as my first dose of COVID-19 vaccine?

The Janssen COVID-19 vaccine is a TGA approved COVID-19 vaccine and is provisionally approved and recommended to be given as a single dose to people aged 18 years and over.

To meet the COVID-19 vaccination requirements outlined in the Occupational Assessment Screening and Vaccination Against Specified Infectious Diseases (PD2022_030 ) Policy Directive:

• Category B Workers who have received the Janssen COVID-19 vaccine require only 1 dose (1 primary dose).
• Category A workers who have received the Janssen COVID-19 vaccine require 2 doses (1 primary dose of Janssen COVID-19 vaccine and an additional booster dose of a COVID-19 vaccine that is approved by ATAGI as a booster dose).

What if a Category A worker or student is not yet due for their booster COVID-19 dose (dose three), can they be employed?

Yes. The worker will be required to complete the Undertaking/Declaration form declaring that they will receive the booster dose in accordance with Australian Technical Advisory Group on Immunisation (ATAGI) minimum intervals and will provide evidence of completed vaccines within 6 weeks of the dose 3 due date. The worker will need to comply with all other COVID-19 risk reduction strategies including appropriate use of personal protective equipment (PPE)

What if a worker receives their booster dose more than 19 weeks from their second dose? Are they considered compliant?

Yes, they are considered compliant once they have had their third dose and submitted the appropriate evidence. ATAGI have no upper limits between doses.

I am pregnant or planning my pregnancy. What are my options?

You can get vaccinated if you are pregnant, breastfeeding or trying for a baby. Pregnant women are particularly vulnerable to COVID-19 and should get vaccinated now. Vaccination reduces the risk of severe disease during pregnancy and helps keep you and your unborn baby protected from the virus. mRNA vaccines (Pfizer or Moderna) are the recommended COVID-19 vaccines for pregnant women due to their safety profile. Please refer to the NCIRS COVID-19 FAQs for more information and the COVID-19 vaccination decision guide for women who are pregnant, breastfeeding or planning pregnancy

What happens if I decide not to be vaccinated?

NSW Health requires all workers to comply with the COVID-19 vaccination requirements of PD2022_030 Occupational Assessment Screening and Vaccination Against Specified Infectious Diseases. All NSW Health Service employees are also required to comply with the Determination. If you do not meet the COVID-19 vaccination two dose requirement, or do not have an approved medical exemption, you cannot continue to work within NSW Health.

New Category A workers and Category A students must have three doses of a COVID-19 vaccine to commence employment/placement with NSW Health. If you do not have an approved medical exemption to all available TGA approved COVID-19 vaccines, you cannot commence employment/placement. Temporary compliance may be granted if your third dose is not yet due (Refer to What if a Category A worker or student is not yet due for their booster COVID-19 dose (dose three), can they be employed?).

Existing Category A workers who are non-compliant with the COVID-19 three dose requirements must comply with all other COVID-19 risk reduction strategies including appropriate use of personal protective equipment (PPE) and complete and submit Appendix 5 Non-Participation Form of the Policy Directive. For those existing Category A workers who do not comply with these requirements and/or who do not have an approved medical contraindication, termination of employment may be appropriate. The NSW Health agency will ensure procedural fairness during this process.

What if I cannot be vaccinated because of a medical reason?

An exemption from the two dose COVID-19 vaccination requirements will only be considered if you are unable to be vaccinated against COVID-19 for a valid medical contraindication. You will only be granted an exemption if you have a medical contraindication to all the available COVID-19 vaccines, or you have another medical reason for a temporary exemption. A temporary exemption may be granted for up to four months for people with conditions recognised in the ATAGI expanded guidance on acute major medical conditions that warrant a temporary medical exemption relevant for COVID-19 vaccines.

The only acceptable evidence of a medical contraindication is the Australian Immunisation Register (AIR) - Immunisation medical exemption form (IM011). You will need to speak to your medical practitioner and ask them to complete the form.

Any NSW COVID-19 vaccine medical contraindication forms issued on or before 24 February 2022 remains valid for the period for it which was granted.

All medical exemptions are subject to the review and approval of your engaging NSW Health agency.

What happens if my application for a medical exemption is approved? What does this mean for my ongoing employment, role etc.

You will generally continue to be able to work in your current role, noting that risk mitigation strategies will continue to be in place. Where the nature of the medical contraindication could adversely impact your ability to perform your role safely, a risk assessment will be undertaken to address any concerns.

If you have a temporary medical contraindication the medical contraindication will be reviewed at the end of the temporary contraindication period to determine if the medical contraindication remains valid. As more information becomes available on COVID-19 vaccines, the medical contraindication you currently experience, may not prevent you from receiving a COVID-19 vaccine in the future.

What happens if my application for a medical exemption is not approved?

Medical contraindications will only be accepted if they are in accordance with the Australian Immunisation Register - Immunisation medical exemption form (IM011). If you have a medical contraindication to a specific COVID-19 vaccine, discuss with your medical practitioner whether you can receive an alternative COVID-19 vaccine.

If you do not have an approved medical exemption, you will be required to have at least 2 doses of COVID-19 vaccine to work in NSW Health.

What if I have had COVID-19 recently?

Workers who have had COVID-19 may delay their further COVID-19 vaccination for up to four months after confirmed infection. Temporary compliance will be granted if the worker provides the required evidence as stated in section 5.5.1 of the policy directive.

What about rapid antigen testing? Can I do that instead of getting vaccinated?

Rapid antigen testing is not an alternative to vaccination.

Can I get vaccinated in work time?

Please talk to your manager about when your appointment is so that rosters can be managed accordingly and/or flexible working arrangements to accommodate absence can be discussed.

If you are vaccinated in your own time you can claim a two-hour special leave payment on each occasion of COVID-19 vaccination.

Is there vaccination information in languages other than English?

The Australian Government has added translations in 15 languages. Languages currently included: Chinese, Simplified Chinese, Arabic, Vietnamese, Italian, Greek, Punjabi, Korean, Turkish, Bengali, Serbian, Khmer, Spanish, Hindi and Assyrian.

What if I have been vaccinated overseas?

Under the revised PD2022_030 Occupational Assessment Screening and Vaccination Against Specified Infectious Diseases, vaccines that are provisionally approved or recognised by the TGA are accepted.

How do I book an appointment?

Appointments can be made in the first instance, via the COVID-19 Vaccine Finder at a NSW Vaccination Clinic, your GP or a community pharmacy.

LHD vaccination team contacts

How can I prove I have been vaccinated?

There are a number of ways you can receive your 'proof of vaccination':

• Download your COVID-19 digital certificate via the Express Plus Medicare mobile app or your Medicare online account through myGov.
• You can add your COVID-19 digital certificate to your Apple Wallet or Google Pay.
• Instructions are available on the Services Australia website.
• Your vaccination provider may be able to print your immunisation history statement.
• Call the Australian Immunisation Register on 1800 653 809 (Monday to Friday 8am to 5pm) and ask for your statement to be sent to you. It can take up to 14 days to arrive in the post.
• If you're not eligible for Medicare, call the Australian Immunisation Register and request your certificate be mailed to you or add your COVID-19 certificate to your digital wallet using the Individual Healthcare Identifiers service (IHI service) through myGov.

Who should I send my vaccination record to?

Your vaccination records should be sent to your local staff health unit at your local health district, network or health pillar. If you do not have a staff health unit, you will receive further advice from your manager.

If you were vaccinated at a NSW Health COVID-19 Vaccination Hub and provided your employee number, your vaccination details should already be stored in VaxLink (the Staff Vaccination and Compliance database for NSW Health). However, if you were vaccinated elsewhere such as your local GP or Pharmacy then evidence of you vaccination needs to be provided to NSW Health.

You can upload your vaccination records in Stafflink by using the Vaccination Evidence Form in the Employee Self Service menu that allows NSW Health employees to attach and submit evidence of their COVID-19 vaccinations. The evidence will be reviewed by your staff health unit or designated approver and updated in VaxLink.

I am concerned about the privacy implications of reporting my vaccination status. How will this information be held and what will my manager access?

All vaccination information is securely stored in the NSW Staff Health vaccination database called VaxLink. Only authorised staff can view vaccination records.

Managers will be able to view their staff member's vaccination compliance status only.

Who can see my vaccination status?

All employees can see their own vaccination status by logging into employee self service in StaffLink. Managers can view the vaccination status by logging into manager self service in StaffLink

What leave is available if I have an adverse reaction to the vaccination?

You can access available sick leave if you experience any side effects to the vaccination.

Will I have access to workers compensation if I suffer long-term adverse effects from the vaccination?

An employee can lodge a claim for workers' compensation if they suffer an illness or injury as a consequence of vaccination.

Any such workers' compensation claim will assessed in accordance with NSW Workers Compensation and Injury Management legislation.

I am currently on leave (e.g. annual leave, maternity or long service). When am I required to have the vaccine? Can this be done prior to my return to work?

If you are already on leave at the time vaccinations are due, you are still encouraged to get your COVID-19 vaccination as this in your best interest to protect you and your family. Please note, you are required to have had your vaccination(s) before you return to duty and will be required to provide evidence of your vaccination status prior to resuming duty.

Where can I find more information about COVID-19 vaccines?

For more information visit the National Centre for Immunisation Research and Surveillance.