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* 1. Your name

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* 2. Your workplace

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* 3. Your workplace location

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* 4. Your mobile

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* 5. Have workers left your workplace because of mandatory vaccinations?

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* 6. If yes, how many workers have left?

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* 7. If yes, what are your concerns about your workplace? Please tick all that apply.

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* 8. If yes, has your workplace already changed rosters? Please tick all that apply.

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* 9. Are there any other comments or concerns you would like to raise?

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