Thank you for taking the COVID CRUSHER TRIFECTA Challenge!

COVID-19 Staff Vaccination

Please complete with vaccination rate as of the date submitted. We appreciate your efforts and willingness to share. We want to recognize and highlight those homes with high staff vaccination rates throughout the IPRO 12-state region in an effort to help those who are encountering barriers.

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* 1. Please enter your contact information:

First Name

Last Name

Title

Organization

City/Town

State/Province

ZIP/Postal Code

Email Address

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* 2. Date:

Date:

Date

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* 3. As of today (date indicated above), the following percentage of our staff have been vaccinated:

25 - 50%

51 - 75%

76% and Higher