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DD Form 3175, "CIVILIAN EMPLOYEE CERTIFICATION OF VACCINATION"-2026
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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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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2021 | 4.8 Satisfied (21 Votes) |
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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 The Secretary of Defense later rescinded the mandate on January 10, 2023.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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People also ask
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.
Related links
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Nov 7, 2021 DD Form 3175 - DoD Civilian Employee Certification of Vaccination. CUI (when filled in). DoD CIVILIAN EMPLOYEE CERTIFICATIoN OF VACCINATION.Read more
DD FORM 3175, OCT 2021. DoD CIVILIAN EMPLOYEE CERTIFICATION OF VACCINATION DD FORM 3175, OCT 2021. 4. EMPLOYEE VACCINE INFORMATION (Employees checkingRead more