Fall 2021 – Farm Worker COVID-19 Vaccination Update

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Fall 2021 – Farm Worker COVID-19 Vaccination Update

Thank you very much for your participation in this survey regarding COVID-19 health and safety for farm workers! Given the rise of the COVID-19 Delta variant, the NJ Department of Health's Office of Primary Care and Rural Health wants to ensure that you and your workers are supported with COVID-19 education and vaccinations, based on your level of need.

Any information you provide will be confidential and used solely for supporting COVID-19 vaccination efforts. With your cooperation, we look forward to having all our farm families and farmworkers vaccinated early in the 2021 fall season!

What is the name of the farm you are associated with? ✱

What is the address of the farm you are associated with? ✱

Street Address	An answer is requiredStreet Address
Zip Code	An answer is requiredZip Code
City	An answer is requiredCity
County	An answer is requiredCounty

What is your name?

What would be the best email address for us to contact for follow up? ✱

This information is confidential and will only be used for follow-up regarding COVID-19 health and safety for farm workers.

What would be the best phone number for us to contact for follow-up? ✱

This information is confidential and will only be used for follow-up regarding COVID-19 health and safety for farm workers.