Signing example
Sign a vaccination consent form online
A vaccination consent form has to capture the screening answers before the injection and the batch number after it, on the same page, in that order. This one page workplace flu clinic consent is signed by the employee first, with one screening answer marked, and completed by the immunising nurse, who types the batch from the vaccine box and signs below.
The document, with its fields
The pages as a signer sees them, with the signature, name, title and date fields placed where each party has to complete them.
Workplace Influenza Vaccination Consent
| Employee | Mereana Tautahi, warehouse team leader, staff number CL-3302, date of birth 17 June 1991 |
|---|---|
| Vaccine | 2026 seasonal influenza vaccine, 0.5 mL by injection into the upper arm muscle, one dose, free to employees |
The vaccine cannot give you influenza. A sore arm, mild fever or tiredness for a day or two are common. You wait 15 minutes in the clinic room afterwards in case of a rare allergic reaction. The nurse reports the vaccination to the Australian Immunisation Register, as the law requires, so it appears in your immunisation history. Calloway Logistics is told only that you attended, never your answers below.
Screening questions
Type an X beside any statement that is true for you today. An X means yes; an empty box means no.
| Yes | Statement |
|---|---|
| I am unwell today with a fever above 38.5°C. | |
| I have had a severe allergic reaction (anaphylaxis) to a vaccine or any of its ingredients. | |
| I am pregnant, or may be pregnant. (Influenza vaccine is recommended in pregnancy.) | |
| I have had Guillain-Barré syndrome within six weeks of a previous influenza vaccine. |
Consent, signed by the employee before vaccination
I have read the information above, answered the questions truthfully and had the chance to ask questions. I consent to receiving the influenza vaccine today.
Vaccination record, completed by the immuniser, Sarah Okonjo RN, after the employee signs
The batch number is typed from the vaccine box at the time of injection, so it matches the dose given.
Who signs what
- Mereana Tautahi, employee
- Four screening questions, an X beside any that are true · Signature, stamped date and name · Email link
- Sarah Okonjo, immunising nurse
- Batch number typed from the vaccine box · Signature and stamped date · Email link
The signing journey
Step 1
Ten fields on one page
Four optional checkboxes, a signature, a date and a name for the employee, then a batch number, a signature and a date for the nurse.
Step 2
Employee answers and signs
Mereana types an X beside the pregnancy statement only, which the form notes is a reason the vaccine is recommended, and signs.
Step 3
Nurse invited after the employee
Sign in order holds Sarah's link until Mereana's signature lands, so the batch cannot be recorded against an unsigned consent.
Step 4
Batch typed at the injection
Sarah types FLU26-AX4471 from the box of the dose she gives, then signs. Her date is stamped from the moment she finishes.
Every field, and who fills it
Mereana Tautahi types an X beside I am pregnant, or may be pregnant, leaving fever, anaphylaxis and Guillain-Barré empty. She draws her signature beside a stamped date, and her full name fills from her recipient record. In the section below, Sarah Okonjo types the batch number on its ruled line, draws her signature and gets her own stamped date. The vaccine, dose, clinic date of Sunday 4 October 2026 and the employer's Port Melbourne depot are printed in the PDF.
How to adapt this envelope
A clinic of forty staff is forty envelopes, one per employee, each with the same nurse as second recipient, so every record is separate and private. A school program uses the parent as first recipient and adds the child's name to the printed table. A clinic giving two vaccines adds a second batch line for the nurse, labelled for each vaccine.
What makes this valid in Australia
The Electronic Transactions Act 1999 recognises an electronic signature that identifies the signer and shows intention, by a reliable method. The Australian Immunisation Handbook sets out the pre vaccination screening that immunisers use, and vaccinations are reported to the Australian Immunisation Register, which is why the batch number is recorded at the time of the dose.
What makes this signing flow work
Two sections, two people, one page
The consent and the vaccination record sit on the same sheet, so the batch number can never be separated from the consent it belongs to. Each section belongs to a different recipient, shown in two colours in the editor.
The batch comes after the signature
With the order on, the nurse cannot type anything until the employee has signed. The finished page shows the batch number typed by the nurse, and the event log shows her invitation sent after the employee's signature.
Screening where an empty box is a no
The four checkboxes are optional, so Mereana could leave three empty and mark one. The form explains above the table that an X means yes, which makes the single X readable on its own.
Questions people ask
Why does the nurse sign the same envelope as the employee?
Because the consent and the record of the dose belong together. The employee consents, the nurse vaccinates and records the batch, and both sections end up in one certified PDF with one certificate showing who signed each part and when.
Can the employer see the screening answers?
The form says the employer is told only that the employee attended. The envelope is sent by the clinic provider, not the employer, and the certified PDF goes to the two signers and the sender. Who else sees it is up to the provider's privacy practices.
What if the employee answers yes to fever or anaphylaxis?
An X on either tells the nurse to stop and talk before vaccinating. If the nurse decides not to vaccinate, she declines the envelope with a reason instead of signing, so no batch is recorded and the sender is emailed why.
Can the employee sign on a phone in the queue?
Yes. On a narrow screen the four boxes move into a panel above the page, she taps the ones that apply and types an X, draws her signature and finishes. The nurse's invitation then arrives on her own device, and the employee can go straight to the vaccination chair.
Is a vaccination consent valid when signed electronically?
In Australia, yes, where the method identifies each signer and shows intention, which the Electronic Transactions Act 1999 accepts. Valid consent still depends on the person being given the information first, which the paragraph above the screening questions provides before anyone signs anything.
What does the certificate add to the form?
For each of the two signers it records the verification method, signing time, IP address, consent time and version, and the hash of the document at signing. The event log shows the nurse's invitation after the employee signed, which proves the sequence on the page.
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