Wisconsin COVID-19 Vaccine Program

Attestation Survey For Youth Ages 5-11 COVID-19 Vaccination Training

The Wisconsin Department of Health Services (DHS) requires that all sites vaccinating youth ages 5-11 attest that your staff are fully trained prior to beginning your 5-11 year-old COVID-19 vaccination programs. Sites that plan to vaccinate youth ages 5-11 must complete the following steps.

Step 1. Please ensure your staff have reviewed the materials listed below.

Step 2. The site CEO, CMO, Primary or Back-up Coordinators, or their equivalent should complete the Attestation Survey for 5-11 Year Old COVID-19 Vaccine Training.

The survey should take less than two minutes to complete. The following questions will be asked.

1. Your location name
2. Your site pandemic PIN (also called VFC PIN)
3. Your name
4. Your role
5. The best phone number to reach you
6. Your email address
7. If you plan to administer the Pfizer COVID-19 vaccine for youth ages 5-11.
8. You’ll then be asked to confirm that all vaccinators at your site have read and understand the following materials:

• Vaccinators have read and understand the Interim Clinical Considerations for Use of COVID-19 Vaccines as related to vaccination with the 5-11 year-old COVID-19 vaccine product. We anticipate that this will be updated after the November 3, 2021 ACIP meeting.
• Vaccinators have reviewed and understand the content on the Pfizer Storage and Handling website regarding the 5-11 year-old COVID-19 vaccine storage and handling requirements. 
• Vaccinators have reviewed and understand the information on the Pfizer-BioNTech COVID-19 Vaccine EUA Fact Sheet for Health Care Providers and that a new Vaccine Information Fact Sheet for Recipients and Caregivers about Pfizer-BioNTech COVID-19 must be distributed to parents/care takers prior to their child receiving COVID-19 vaccine.
• Vaccinators have reviewed and understand the Pfizer Pediatric Reference Planning Document.
• Are your vaccinators trained on your plan for handling adverse events (for example, anaphylaxis) with youth ages 5-11 years per CDC’s guidelines?
• If your plan is to call 9-1-1 as a primary support, are the responding agencies equipped, trained, and available in the required response time frame to manage adverse reactions in 5-11 year-old pediatric patients?

In addition, vaccinators are encouraged to view the following:

• Vaccinators should attend the panel discussion about COVID-19 Vaccination in Youth 5-11 Years Old held on Wednesday, November 3, 2021, from 8:30-9:30 a.m. or view the recording if unable to attend in person. Panelists will discuss clinical updates, vaccine administration, best practices for vaccinating children ages 5-11, and tips for vaccinating in a pharmacy or community clinic setting.
  • Please click on this link at the time of the webinar https://dhswi.zoom.us/j/81455810034
  • Call: 1-312-626-6799
  • Webinar ID: 814 5581 0034
  • A recording of the webinar will be posted to our website by the end of the day 11/3/2021: https://vimeo.com/showcase/8511959
• Vaccinators have or will have reviewed the WIR training modules.
  • Recordings can be found at: https://vimeo.com/showcase/8701436. These are the original videos required with COVID-19 vaccinator enrollment.

Thank you for your time and attention to ensuring all of your vaccine staff are fully trained. We appreciate your partnership in protecting this new eligibility group.

Please do not reply directly to this email message. If you have a question, please email DHSCOVIDVaccinator@wi.gov.