DD Form 3175, "CIVILIAN EMPLOYEE CERTIFICATION OF VACCINATION"-2026

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The document is a certification form for DoD civilian employees to report their COVID-19 vaccination status, mandated under various federal laws and executive orders. It outlines the privacy act statement, the purpose of collecting vaccination information, potential consequences for failing to provide this information, and instructions for completing the form. Employees must indicate their vaccination status and provide necessary documentation, while supervisors are responsible for reviewing this information.

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Click ‘Get Form’ to open the DD Form 3175 in the editor.
In Section A, enter your name (Last, First, MI) and DoD ID number. This identifies you as a DoD civilian employee.
Check the appropriate box regarding your COVID-19 vaccination status. Options include fully vaccinated, partially vaccinated, submitted proof of vaccination, not vaccinated, pending exemption request, or approved exemption.
If applicable, provide details about your vaccine in Section 4. Include the manufacturer’s name and dates of doses received.
Sign and date the form in Section 5 to certify that all information is accurate and true.
Submit the completed form to your supervisor for review in Section B. Ensure they complete their part before final submission.

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What is considered proof of vaccination?

A record from a healthcare providers medical record system (including a patient portal) that is either a: Vaccine Administration Record from the facility where the vaccine was administered that includes the: Vaccine administered.

Does the military require you to be vaccinated?

On August 24, 2021, the Secretary of Defense mandated that all service members receive the COVID-19 vaccine. The Secretary of Defense later rescinded the mandate on January 10, 2023. The vaccine mandate was an unfair, overbroad, and completely unnecessary burden on our service members.

How to show proof of immunity?

There are two ways to verify immunization history: Vaccination records from health care providers: Confirm when, where and by whom certain vaccines were administered. When these records are unavailable: Results of a blood titer test can provide the documentation that a school or workplace may need.

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Is proof of vaccination a HIPAA violation?

Disclosure of an Individuals Vaccine Status by a Healthcare Provider. Healthcare providers can ask if a patient has been vaccinated as asking the question in no way violates HIPAA.

What is required documentation when giving a vaccine?

The National Childhood Vaccine Injury Act requires that a VIS must be given to parents, legal representatives, or adult patients before administering the vaccine. A VIS must be provided prior to each dose, not just the first dose. Providers should be sure they are using the most current version of each VIS.

How do I find out if I am vaccinated?

If you dont have a record of the immunization, try contacting the healthcare provider or regional health authority where you were immunized.

How to check if youve had a vaccination?

This service allows you to view your COVID-19 vaccine record via the NHS app. Your record shows you information about the type of vaccine you had and the date you had it.

DD Form 3175, "CIVILIAN EMPLOYEE CERTIFICATION OF VACCINATION"-2026

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How to use or fill out DD Form 3175, "CIVILIAN EMPLOYEE CERTIFICATION OF VACCINATION" with our platform

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Can I fill out and sign my DD Form 3175, "CIVILIAN EMPLOYEE CERTIFICATION OF VACCINATION" online?

How do you fill out DD Form 3175, "CIVILIAN EMPLOYEE CERTIFICATION OF VACCINATION" on Android?

What is considered proof of vaccination?

Does the military require you to be vaccinated?

How to show proof of immunity?

Security and compliance

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Is proof of vaccination a HIPAA violation?

What is required documentation when giving a vaccine?

How do I find out if I am vaccinated?

How to check if youve had a vaccination?

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