• CO Department of Public Health & Environment

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    June 10, 2021
    Workplace Vaccination Program Event Request Form
    This request form is for business organizations to request a vaccination event for their employees. Upon filling out this form, you will receive a response from a CDPHE representative who will schedule an event for your organization. Please note: as a public program, media entities may be invited or present. If your organization has a legitimate concern about media presence, please indicate this on your request.

    This form is NOT to be used for entry into the Colorado Comeback Cash drawing. Colorado residents who have received at least one dose of a Covid-19 vaccine are eligible*. If you would like to confirm your Covid-19 vaccine status, please check on this portal: https://ciis.state.co.us/public/Application/PublicPortal

    ***If you are an individual looking to schedule a vaccination for yourself, please go here: https://covid19.colorado.gov/vaccine/where-you-can-get-vaccinated

    *Some exceptions apply to eligibility. More details can be found here: https://covid19.colorado.gov/coloradocomebackcash