The intent of this form is to capture contact and employee information for businesses interested in COVID-19 vaccine for their employees. This is not intended to capture individuals who want to receive the vaccine. Priority for vaccination will be based on the prioritized populations outlined by the CDC. By submitting your information to this form, there is no guarantee that vaccine will be available to your facility.
By completing this form, you confirm that:
Currently, our registration form is only intended for local employers. Members of the general public can subscribe to our Notify Me list for COVID-19 updates.
Black Hawk County Public Health is working with our state and community partners to distribute the COVID-19 vaccine as the limited supply becomes available by phase. We want to keep you informed every step of the way. Please subscribe to receive Black Hawk County COVID-19 Status Updates by using our Notify Me tool and selecting the "Black Hawk County Health Department COVID-19 Notification" list.
Thank you for completing our Vaccine Registration for Employers. Please keep in mind that there is no guarantee that vaccine will be available to your facility. If your vaccine does become available for your group, we will contact you to arrange distribution.