This template is a certification for employers to collect information from employees confirming receipt of the COVID-19 vaccine and/or booster shot. This template includes practical guidance, and drafting notes. This template is intended for private employers. It has not been tailored for any jurisdiction. Use this template alone or customize it for one or more jurisdictions. Companies that decide to implement a COVID-19 vaccine policy – be it a mandatory policy requiring employees to obtain the vaccine or a non-mandatory merely suggesting vaccination – should collect written proof of vaccination from their employees. Such proof may include a copy of an employee's vaccination card and/or a certification, such as the instant template, attesting to vaccination. For a template policy requiring employees to obtain the coronavirus (COVID-19) vaccine to minimize transmission of the virus in the workplace, see Coronavirus (COVID-19) Vaccine Policy (Mandatory). For a template policy strongly ...