Vaccinating Buffalo Niagara’s Workforce: Employer Vaccination Clinic Interest Form

Dear Employer:

The Buffalo Niagara Partnership is working with the State of New York and local governments to determine how employers can help deploy COVID-19 vaccines in our region. Vaccinating the collective work force is the best way to fully re-open Buffalo Niagara’s economy and move our community forward.  We anticipate a growing need for vaccine distribution beyond facilities with existing onsite occupational health programs and are requesting information from our members to help direct public resources as quickly as possible.

Complete the following questionnaire to help the BNP properly assess current needs and identify future vaccination administration sites. The information provided will only be shared with the relevant vaccination partners in support of vaccine distribution.

A. General Information
First Name*
Last Name*
Job Title*
Business Name*
Business Address*
Total number of employees:
Do you know the approximate number of employees who are willing to be vaccinated?
Do you foresee any resistance from your employees to take the vaccine?
If you answered yes above, would you be interested in material and information that would help provide details about the vaccine to your employees?
B. On-Site Clinic in Partnership with External Resource
Are you interested in potentially holding a clinic(s) onsite with an external resource (County Health Dept, pharmacy, etc.) to administer the vaccine to your employees?*

*Please note, if you plan to answer yes, your business will need to meet requirements set by the pharmacy/government agency administering the vaccine. Below, please find the most common requirements set by POD partners in our region:  

  • Support scheduling and recruit participants 
  • Distrubtion appointment registration/link information to your workforce 
  • Guarantee at least 50 people for vaccination 
  • Provide site staff or volunteers to great and direct patients and monitor lines 
  • Provide tables and chairs for vaccination stations, a waiting area and a post-vaccination waiting area 
Are you interested in allowing members of the public into your facility for vaccination?
C. On-Site Company Managed Clinic
Are you interested in holding clinics onsite using your INTERNAL MEDICAL RESOURCES to administer the vaccination of employees?
Do you have occupational health onsite?
Do you have Registered Nurses who can assist with administering the vaccination, and if so - how many?
Have you enrolled in the NYS COVID 19 Vaccination Program?
Is there a large open space that can be used for a clinic?
Would you be willing to host a vaccine administration at your site that other local companies could access for a fee?
Are you interested in allowing members of the public into your facility for vaccination?
For more information about COVID-19 vaccine access, policy and communication for employers please visit the Buffalo Niagara Partnership’s COVID-19 Resources & Impacts page at

Please reach out to Seth Piccirillo, Director of Economic Development, at with any questions.