Online COVID-19 Vaccination Reporting for Out of Province Records

Contact Information

* First name

* Last name

* Reason for submission Select one... Niagara resident Extended stay if attending an educational institution in Niagara Extended stay for temporary foreign workers Extended stay if seeking vaccination while staying in Niagara Workplace requirement in a high risk setting

* Phone number
xxx-xxx-xxxx

* Email

* Gender Select one... Female Male Non-binary / third gender Prefer not to say Unknown Other

* Date of birth Month JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Day 12345678910111213141516171819202122232425262728293031 Year 2023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900189918981897189618951894189318921891189018891888188718861885188418831882188118801879187818771876187518741873

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Niagara address
If you don't have an Niagara address, wait until you have one to submit your record

* Street number

* Street name

* City

* Postal code

Identification Information

If you choose to submit a valid Ontario health card number, you will have access to the province portal to print your QR code receipt. If you do not have an Ontario health card, you have the option of entering a COVID-ID, non-Ontario health card, passport or licence number.

Non-Ontario health card, licence and passport numbers cannot be used to access the provincial portal, these are used for identification purposes in the provincial vaccination database.

Do you have an Ontario health card? Yes
No

Ontario health card number

COVID-ID number
  xxx-xxx-xxxx
Unique number assigned to you by your public health unit in place of an Ontario health card number

Personal Information

School name (if attending in September 2023)

Employer

Doctor's first name

Doctor's last name

Doctor's city

Reporting Information

Your COVID-19 vaccine certificate (record of immunization) is required to report your out-of-province vaccine. Contact your health care provider who administered the COVID-19 vaccines to get a copy of your vaccine certificate.

Vaccines administered in Canada

If your vaccine is received outside of Ontario but in Canada, proof of vaccine must be in the form of an enhanced vaccine certificate with a QR code. Consult with the relevant provincial or territorial website for information on how to get the enhanced certificate.

Vaccines administered outside of Canada

If your vaccine is received outside of Canada, you may show your own country's or jurisdiction's vaccine certificate to prove that you are vaccinated and must show your valid non-Canadian passport or NEXUS card as ID.

American Centers for Disease Control cards require additional proof of vaccination. Contact the clinic that provided your vaccination and request additional proof of vaccination (such as a scannable QR code, prescription receipt from the pharmacy or an electronic document from the clinic or region where your record is from).

Photos of your vaccination record sheet

• Only jpg, png and pdf files are accepted
• Up to 5 MB file size each, no more than 10 MB total

If your proof of vaccination is contained on multiple photos or files, add a vaccine below to add a second photo or file with all the same information.

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+ Add a vaccination

If you reach the photo maximum capacity limit, submit two separate submissions.

Contacting

You may be contacted by a hospital, local public health unit or the Ministry of Health for purposes related to the COVID-19 vaccine (for example, to remind you of follow up appointments and to provide you with a record of immunization). You must consent to this to complete this form.

I consent to receiving follow-up communications by email or phone

Notice of Collection

Any personal information or personal health information submitted will be collected, used, and disclosed, where applicable, by members of Regional staff according to the Municipal Freedom of Information and Protection of Privacy Act or the Personal Health Information Protection Act. Any information you share will only be used for the intended purpose for which it was provided.

For questions or comments about privacy practices, or for more information about the administration of the Municipal Freedom of Information and Protection of Privacy Act in Niagara Region programs, see Freedom of Information and Open Government.