COVID-19: Vaccinator Enrollment
Wisconsin COVID-19 Vaccine Program is continuing to enroll entities that wish to administer COVID-19 vaccine in Wisconsin. This page delineates the steps and other information needed to enroll in the program and get approved to administer COVID-19 vaccine in Wisconsin. To become a COVID-19 vaccinator, all organizations must have an approved Form A, Form B, and Redistribution Form. See the general vaccination guidance page for steps to redistribute vaccine.
Useful links and resources
- Centers for Disease Control and Prevention (CDC) COVID-19 Vaccination Program Provider Agreement
- Standing Prescription Order for COVID-19 Vaccines
- COVID-19 Vaccinator Training & Readiness Checklist, P-03269
- COVID-19 Vaccinator Enrollment Tool
- Wisconsin COVID-19 Vaccinator Enrollment Process, P-03309
- Guide to filling out the provider agreements: Form A, Form B, and Redistribution Form, P-03015
- Provider Registration Scenarios: When to Submit a Form B
- General COVID-19 vaccination guidance: Vaccine redistribution and transfers
- Comparison of Vaccines for Children (VFC) Program and CDC COVID-19 Vaccination Program Requirements
Webinars for stakeholders and vaccinators are held the second Tuesday of every month from 11 a.m. to noon. The Zoom link for the webinar has not changed.
New attendees need to register for this webinar. Once you register, you can use the same Zoom link for every webinar.
Watch recordings of past webinars.
Requirements to administer COVID-19 vaccines
Pharmacists vaccinating children under 6 years
For a pharmacist to administer a COVID-19 vaccine to a child under 3 years of age, the child/patient must have a prescription issued by a health care provider in the previous 29 days. This applies regardless of the provider location (for example pharmacy, physician’s office, mobile clinic) where the child is receiving the vaccine.
Under the Public Readiness and Emergency Preparedness (PREP) Act, pharmacists may vaccinate individuals 3 years and older with the COVID-19 vaccine without a prescription. However, if the pharmacist is following the Wis. Stat. § 450.035 and not using the PREP Act, the pharmacist will need a prescription issued in the last 29 days to vaccinate children aged 3-5 years. No prescription is needed to vaccinate people ages 6 years and older.
Pharmacies will vary in the ages that they are vaccinating, so it will be important if you are referring patients out to be sure the referring entity is vaccinating that age.
For more information on federal actions and Wisconsin law allowing pharmacy vaccination of younger children, see Dr. Ryan Westergaard's memo on COVID-19 Vaccination for Wisconsin’s Youngest Children.
Standing prescription order for COVID-19 vaccines
The Standing Prescription Order for COVID-19 Vaccines authorizes personnel to administer COVID-19 vaccine and highlights requirements related to patient eligibility, staff training, and an appropriate plan of care.
The revised standing order enables Emergency Medical Services (EMS) providers and practitioners to administer COVID-19 vaccine, providing an opportunity for more partnerships at the local level that increase the capacity of vaccinators to meet community demands. For a more thorough overview, see the bulletin about the revised standing order.
Vaccinators who are interested in engaging with local EMS are encouraged to reach out to their local EMS contacts directly to explore potential support and to collaborate with local and Tribal health departments to ensure all vaccinating partners are aware of local capacity.
Providers eligible to administer COVID-19 vaccine through guidance under the PREP Act
Joint guidance on the Public Readiness and Emergency Preparedness (PREP) Act March 11, 2021 Seventh Amendment was issued from:
- Wisconsin Department of Safety and Professional Services (DSPS)
- Wisconsin Veterinary Examining Board (VEB)
Licensed health professionals or other individuals authorized by the state of Wisconsin may administer COVID-19 vaccines. Providers should always consult their governing laws and any policies or guidance issued by the regulatory program, board, or commission for their profession, as well as the Declaration under Public Readiness and Emergency Preparedness Act for Medical Countermeasures Against COVID-19, referred to as the “PREP Act of 2020.” Providers are responsible for complying with the standards of practice and any other legal requirements applicable to their profession when ordering or administering vaccines in Wisconsin. Please refer to the DSPS for additional information.
In addition to licensed health professionals or other individuals authorized by the state of Wisconsin, through the PREP Act Declaration, the federal government has provided a pathway for state, local, territorial, and tribal (SLTT) governments to rapidly expand and support their vaccination workforces as needed. In March 2020, the HHS Secretary issued the PREP Act of 2020 covering COVID-19 tests, drugs, and vaccines providing liability protections to manufacturers, distributors, SLTTs, licensed health care professionals, and others (qualified persons) identified by the U.S. Health and Human Services (HHS) Secretary who administer COVID-19 countermeasures. On March 11, 2021, the HHS Acting Secretary issued the PREP Act Seventh Amendment to extend liability protections to specified health care professionals who may not usually administer vaccines in their scope of practice or who have recently expired licenses, and students of specified health care professions who administer COVID-19 vaccines.
DSPS and DHS have deemed that the following health care professionals who hold an active credential under the law of any state, or hold a credential that has expired, become inactive, or lapsed within the last five years and was in good standing when it expired, lapsed, or became inactive, and who meets all the requirements under the PREP Act Seventh Amendment, are authorized under the PREP Act Seventh Amendment to administer U.S. Food and Drug Administration (FDA) authorized, approved, or licensed COVID-19 vaccines in Wisconsin.
Health professionals (currently licensed, certified, or registered or had active license, certification, or registration within the last five years):
- Registered nurses
- Licensed practical nurses
- Advanced practice registered nurses
- Pharmacy interns
- Physician assistants
- Respiratory therapists
- Emergency medical services providers (EMT, AEMT, EMT intermediate, or paramedic)
All professionals and students
All professionals and students must meet and comply with all applicable requirements outlined in the PREP Act 2020 Declaration and Amendments, as well as any additional training required by the state, territory, locality, or tribal area in which they are prescribing, dispensing, or administering COVID-19 vaccines.
To become a part of the expanded COVID-19 vaccine workforce in Wisconsin, you will need to determine if you meet eligibility requirements and training under the PREP Act of 2020. Subject to certain requirements and if eligible, PREP Act coverage provides liability protections under federal and state/territorial law with respect to all claims for loss resulting from the administration or use of a covered countermeasure in this case COVID-19 vaccine. Some professions may have limitations related to delegation, supervision, training, settings, etc. when ordering or administering vaccines. We encourage providers to consult with their specific program, board, or commission for guidance specific to their profession.
Everyone administering COVID-19 vaccines must complete the DHS required training in the training section below prior to becoming a COVID-19 vaccinator.
Health care students
Students in a medical, nursing, pharmacy, pharmacy intern, midwife, physician assistant, respiratory therapy, dental, podiatry, or optometry training program may also administer FDA-authorized, approved, or licensed COVID-19 vaccines in Wisconsin pursuant to the PREP Act Seventh Amendment.
Students in a veterinary medicine program may also administer FDA authorized, approved, or licensed COVID-19 vaccines in Wisconsin pursuant to the PREP Act Seventh Amendment. Students administering vaccine must have appropriate training in administering vaccines as determined by the student’s school. Students must also be supervised by a currently practicing health care professional with experience in administering intramuscular injections.
The VEB has deemed all veterinarians licensed by VEB (managed by the Wisconsin Department of Agriculture, Trade, and Consumer Protection), or who has a credential that has expired, become inactive, or lapsed within the last five years and was in good standing when it expired, lapsed, or became inactive, from any jurisdiction, and who meets all requirements under PREP Act Seventh Amendment, as authorized under the PREP Act Seventh Amendment, may administer FDA authorized, approved, or licensed COVID-19 vaccines in Wisconsin if properly trained per DHS requirements.
At this time, DHS is not seeking additional locations to administer the COVID-19 vaccine. Individuals interested in administering vaccine are encouraged to enroll through the Wisconsin Emergency Assistance Volunteer Registry (WEAVR) and indicate their interest in providing COVID-19 vaccine. DHS will query individuals enrolled in WEAVR as additional vaccinators are needed to support on-site clinics.
All COVID-19 vaccination sites that registered with the Wisconsin Department of Health Services (DHS) prior to January 1, 2022 must complete a training and enrollment refresher.
All staff who order, handle, and/or administer COVID-19 vaccines at vaccination sites registered with DHS prior to January 1, 2022 should watch the training video and view the corresponding slide deck to complete the process. Vaccination support staff who have recently completed the full list of COVID-19 training requirements within the last six months do not need to complete the refresher.
COVID-19 Vaccinator Training and Enrollment Refresher 2022
Once all required staff have completed the training refresher, one attestation survey must be submitted on behalf of the location. Primary and backup coordinators should monitor their email for an invitation that includes more information and a customized link to the survey. For more information, or to report concerns regarding the training and enrollment refresher program or the above referenced email, please contact DHSCOVIDVaccinator@wi.gov.
All vaccinators ordering, handling, and/or administering COVID-19 vaccines received through DHS, including the primary and back up contacts, must review and understand the following required information and guidelines.
To view this information in a printable format for your internal review see the COVID-19 Vaccinator Training & Readiness Checklist, P-03269.
Clinical protocols and administration requirements
- Review and follow the Centers for Disease Control and Prevention (CDC)’s Interim Clinical Considerations for the use of COVID-19 vaccines in the United States.
- Review all CDC’s COVID-19 Vaccination Training modules.
- Review the Health Care Provider Emergency Use Authorization (EUA) Factsheet(s) for each age-specific vaccine product (Pfizer, Moderna, Novavax, or Johnson & Johnson) in your facility.
- Pfizer and Moderna have multiple products with different dosage and preparation. Be sure to review the factsheet for each presentation.
- The printed information on COVID-19 vaccine packaging may be different from what will be stated on the emergency use authorization (EUA) factsheets. Always follow the information in the latest EUA factsheet over the printed vial label.
- Review the Advisory Committee on Immunization Practices' (ACIP) Vaccine-product-specific recommendations for vaccination protocols.
- Ensure all staff administering vaccines are appropriately trained to manage anaphylaxis and know how to screen for contraindications and precautions.
- Review and/or post guide on Vaccine Administration, P-03253 in your practice. This includes information on needle gauge and length for intramuscular (IM) injection, the “7 rights” of vaccine administration, and recommended IM injection techniques.
- Be aware of CDC’s guidance for IM vaccination for children ages 11 months and younger, 1-2 years, 3-6 years, 7-18 years, and adults 19 years and older.
- Refer to the current standing orders for each age-specific vaccine product at your facility (Pfizer, Moderna, Novavax, and Johnson & Johnson).
- Report all adverse events to the various systems in place to monitor the safety of COVID-19 vaccines. This includes the requirement to report to the Vaccine Adverse Events Reporting System (VAERS), and the Bureau of Communicable Diseases Emergency Response 24/7 line at 608-258-0099. For more information, review CDC’s factsheet about VAERS.
Vaccine storage and handling requirements
- Review the CDC's Vaccine Storage and Handling Toolkit, and meet all requirements of the CDC's vaccine storage and handling guidelines.
- Ensure a written cold chain plan and procedures is in place for receiving, storing, and handling vaccine. This plan should incorporate the most recent guidance from CDC.
- Ensure all vaccine locations must have the proper storage and handling equipment and temperature monitoring devices. It is necessary to properly maintain temperatures, especially if transporting vaccines to off-site clinics or drive-thru clinics.
- Manage your vaccine inventory by monitoring expiration dates weekly, rotating stock as needed, and following a “first in, first out” strategy.
- Check posted manufacturer information for the most up to date expiration/extension information for Pfizer-BioNTech, Moderna, Novavax, and Johnson & Johnson COVID-19 vaccines. Update expiration dates accordingly in WIR.
- Alert the Wisconsin COVID-19 Vaccine Program at DHSCovidVaccinator@wi.gov immediately if:
- You are not ready to receive a shipment, require fewer doses, or have any questions about shipment. Please include “Vaccine Shipment” in the subject line.
- There is any risk of vaccine spoilage or wastage because of low uptake or other reasons. DHS may reallocate the vaccine to other sites.
Wisconsin Immunization Registry (WIR) requirements
- Review all five online WIR Training Modules.
- Enter each administered dose into WIR within 24 hours of administration.
- If using an electronic health record (EHR), all vaccinators have ensured that the EHR is set up to document COVID-19 vaccine doses and submit patient level data to WIR within 24 hours of administration.
- Maintain accurate COVID-19 vaccine inventory in WIR, including updating expiration dates and reporting vaccine wastage.
- Acknowledge that all trained staff are using WIR for COVID-19 vaccine management and reporting of administered doses. It is a critical component of ensuring vaccine coverage and accountability.
Vaccination clinic planning requirements
- Follow the vaccine ordering process steps and be aware of the vaccine ordering amounts and timelines.
- Use the Wisconsin COVID-19 Vaccine Exchange. This is especially important if you may not be able to use all the vaccine doses before the expiration date or beyond-use date. The recorded webinar from June 8, 2021 includes an overview and background information about the Wisconsin COVID-19 Vaccine Exchange, starting at minute 16:00.
- Ensure that other parties that you might exchange vaccines with have a Redistribution Form on file. DHS requires all Wisconsin vaccinators to complete a Redistribution Form.
- Ensure the location’s enrollment paperwork is kept up to date, and that proper paperwork is on file for each location where the vaccine is being stored overnight. Some exceptions may apply; see Provider Registration Scenarios: When to Submit a Form B.
- Maintain your Vaccines.gov profile and make sure your public display is turned on so the public can find your vaccination site. See more instructions below in Step 7,
- Assess the all people ordering, handling, and/or administering COVID-19 vaccines in Wisconsin using CDC's Competencies Checklist.
Patient education requirements
- Distribute the following to each recipient:
- The age- and product-specific (Pfizer, Moderna, Novavax, or Janssen) EUA factsheet for Recipients and Caregivers.
- A COVID-19 vaccine record card. Blank copies are provided with vaccine shipments.
- The double-sided v-safe information sheet that includes a QR code to access v-safe and encourages participation after receiving a COVID-19 vaccine. For more information, visit the V-safe After Vaccination Health Checker.
- Establish a communications plan to remind patients to come back for their next dose.
- Schedule their next appointment, if possible, and give the patient a note about when to come back for their next dose.
- Supplement the vaccine appointment note with text messages, phone call, or email reminders.
- Use Reminder/Recall or Benchmark Report from WIR, or your electronic medical record (EMR), to remind patients when to come back.
- Distribute the following to each recipient:
In addition to reviewing the required COVID-19 vaccinator trainings for all age populations listed on this webpage, vaccinators are encouraged to review and understand the following required items prior to being able to administer COVID-19 vaccines to patients aged 6 months–11 years.
Enrolled providers who are just beginning to vaccinate children under 11 years must fill out the Pediatric Vaccination Training Attestation Survey. However, providers who have already attested to completing the trainings for vaccinating youth 5–11 years do not need to complete any additional attestations.
- Ensure the facility has updated vaccination protocols and standing orders in accordance with the:
- Interim Clinical Considerations for Use of COVID-19 Vaccines as related to vaccination with each COVID-19 vaccine product.
- Age- and product-specific EUA fact sheets for health care providers (Pfizer and Moderna).
- Review the different Pfizer and Moderna COVID-19 vaccine presentations for each age group.
- Give parents or caretakers the product-specific vaccine information fact sheet for recipients and caregivers (Pfizer or Moderna) prior to their child receiving the COVID-19 vaccine.
- Update your Vaccines.gov profile to indicate the minimum age of patients eligible for vaccine administration at your vaccination site.
- Ensure that preparation, considerations, and capabilities for managing anaphylaxis are appropriate for children.
- Age and size appropriate emergency supplies must be available, including age-appropriate epinephrine dosing and blood pressure cuffs. You must have at least 3 or more doses of epinephrine on hand for each age group that you vaccinate.
- If your plan is to call 911 as primary support, ensure the responding agencies are equipped, trained, and available to respond in the required time frame to manage adverse reactions in children.
- Train all vaccinators on your plan for handling adverse events in children. All staff administering vaccines must be prepared to manage anaphylaxis.
See below for further recommended trainings.
New vaccinators may need additional trainings or to review additional resources to feel comfortable providing the COVID-19 vaccine. The following are recommended for new vaccinators and can be used by experienced vaccinators as a review.
Vaccination clinic planning recommendations
- Ensure supply of personal protective equipment (PPE) is adequate for vaccination clinics.
- Follow the CDC’s Pre-vaccination Checklist for COVID-19 Vaccines.
- Check out CDC’s COVID-19 Vaccination Planning and Partnership webpage.
- Explore CDC’s Training and Education for COVID-19 Vaccination.
- Review the DHS COVID-19 Vaccinator website and monitor your email regularly for COVID-19 vaccine updates and other important information.
- Register for the COVID-19 Vaccine Planning and Updates webinar, or view past recordings on the DHS website.
- Review resources on the manufacturer webpages (Pfizer, Moderna, Novavax, or Johnson & Johnson).
Patient education recommendations
- Review CDC’s Communication Resources for Healthcare Providers and Staff to help you share clear and accurate information about COVID-19 vaccines, raise awareness about the benefits of vaccination, and address common questions and concerns about what to expect when getting vaccinated.
- Use the CDC Vaccinate With Confidence Framework to promote COVID-19 vaccine.
- Reference answers to frequently asked questions about COVID-19 vaccine on CDC’s Quick Conversations Guide or the Children's Hospital of Philadelphia's Vaccine Education website.
Pediatric (6 months – 11 years) recommendations
- Review CDC’s COVID-19 Vaccination for Children information and resources to help inform vaccination planning and improve vaccine accessibility for children, including children with disabilities.
- View a recording of a panel discussion about COVID-19 Vaccination in Youth 5-11 Years Old. The video includes clinical updates, vaccine administration, best practices for vaccinating children, and tips for vaccinating in a pharmacy or community clinic setting.
- Review and/or post guide on Comforting Children During Vaccination, P-03252 in your practice to help while administering vaccines to children.
- View CDC’s videos on Comfort and Restraint Techniques, Intramuscular (IM) Injection: Supplies (Children Birth through 18 Years of Age), and IM Injection: Sites.
- Guide parents and caregivers to CDC’s COVID-19 Vaccines for Children and Teens page to find information on various topics, including: why children and teens should get vaccinated, vaccine safety, and side effects.
- You Call the Shots: Vaccine Administration
- Health Equity Shared Learning Forum videos featuring local vaccinators and their partners sharing their experiences, practices, and lessons learned.
- Project Firstline's 3.5 minute multi-dose vial injection safety training video walks viewers through the safety steps that should be taken when giving vaccines that come in multi-dose vials, like the COVID-19 vaccines.
- Pfizer and BioNTech host medical updates and immunization training sessions for their COVID-19 vaccines several times a week. Recent updates will be identified at the start of each session to reflect new information and changes.
- Moderna hosts Q&A sessions with their medical science liaisons. These are informal, drop-in forums where you can ask questions about the Moderna COVID-19 vaccine. Information related to the pediatric and adolescent indications will be discussed, including: safety and efficacy information for children 6 months – 17 years of age, ACIP recommendations, storage and administration considerations.
Steps to enroll
It is important that you complete every step in the enrollment process to ensure your submission is processed quickly. Please use Google Chrome or Microsoft Edge when navigating the enrollment tool. Contact DHS by emailing DHSCovidVaccinator@dhs.wisconsin.gov if you have any questions.
You can also view a printable version of these steps in the Wisconsin COVID-19 Vaccinator Enrollment Process, P-03309.
Log in to the COVID-19 Vaccinator Enrollment Tool using your Wisconsin Department of Administration (DOA)/Wisconsin Logon Management System username and password.
- If you do not have a DOA/Wisconsin Logon, please sign up with the Wisconsin
Department of Administration (DOA) by selecting Self-Registration.
- After you accept the user agreement and fill in your profile information, select
DHS Health Reports under Systems You Will Access.
- Proceed to the enrollment tool once your registration is complete.
- After you accept the user agreement and fill in your profile information, select
- If you have a DOA/Wisconsin Logon, proceed to the enrollment tool and log in using your DOA/Wisconsin Logon username and password.
- If you cannot access your existing account, try using the Forgot username/password link below the Log on button to reset the password. Contact DHSCovidVaccinator@wi.gov for assistance if you are
having issues resetting the password.
- If you cannot access your existing account, try using the Forgot username/password link below the Log on button to reset the password. Contact DHSCovidVaccinator@wi.gov for assistance if you are
Note: The information that you enter to generate your form will be permanently
associated with your account. After clicking Generate Form, you will be unable to
change the information entered yourself.
- Enter registrant information into the COVID-19 Vaccinator Enrollment Tool.
- Select the I agree checkbox to confirm the information entered is accurate.
- Select Generate Form, to generate forms specifically for your organization.
- If forms were successfully generated, you should see Adobe PDF links appear at the
bottom of the page, as shown below.
- The forms that you generate will always have the contact and organization information that you entered when you generated the forms. If your organization’s name or contact information changes, email DHSCOVIDVaccinator@wi.gov to update this information in the database.
Note: All forms should be filled out electronically in Adobe Acrobat Reader DC (the free version is sufficient). All signatures must be present on a form before submission. Click on the appropriate hyperlink for the form(s) you need to submit. Each vaccinator organization must have a Form A, Form B, and Redistribution Form on file with DHS.
Depending on your computer’s settings, the forms may default to opening in PDF software other than Adobe. If the forms open in a new web browser window (such as Microsoft Edge or Google Chrome) or another PDF viewing program other than Adobe Acrobat DC, try opening the forms again using these steps:
If using Microsoft Edge:
- In the upper-right corner of the web browser window, you’ll see a Downloads pop-up window, or you can open the Downloads pop-up window by pressing Ctrl + J on your keyboard. Then hover your mouse over the document you want to open and click the file folder icon to Show in folder, as shown below. This will open the file in the folder where it is saved on your computer.
- After the form is shown in its file folder location, right-click the file with your mouse and select Open with Adobe Acrobat Reader DC (or other Adobe Acrobat software), as shown below.
If using Google Chrome:
- The downloaded form should appear in the lower-left corner of the Chrome window (pictured below). Select Always Open in Adobe Reader (if available) or select Show in folder.
- If you selected Always Open in Adobe Reader, you will need to click the down arrow again and click Open to view the file.
- If you selected Show in folder, right-click the file in the folder on your computer. Choose Open With and select Adobe Acrobat Reader DC software.
- If the form does not appear in the lower-left corner of the Chrome window, go to the location where the file is saved. Right-click on the form and select Open With and select Adobe Acrobat Reader DC.
Your organization's legal name and reference number will be pre-populated at the bottom of each form. Make note of the reference number generated (located at the bottom-right of each generated form) and share it with the appointed primary and backup contacts for each vaccinator location within your organization. This reference number is critical if additional COVID-19 vaccinator enrollment forms must be submitted, or if existing forms require updating.
Guides to filling out the provider agreement forms
- Each provider organization must complete only one Form A and Redistribution Form. Separate divisions or locations of the same company do not need to submit a form if they fall under the same Chief Medical Officer (CMO) and Chief Executive Officer (CEO).
- There should be one Form B for each location where COVID-19 vaccine is being administered and/or stored.
- Please see these provider registration scenarios to see what forms are required for different vaccination clinics.
- If you have questions about whether your organization requires additional Form B submissions, please email DHS.
- Please see the Guide to filling out the provider agreements: Form A, Form B, and Redistribution Form for important information to help you complete these forms.
Tips for signing enrollment forms
- Electronically sign all signature points on all forms prior to uploading the forms.
- If there are multiple signature fields on the form, all must be signed for the document to upload properly to the Enrollment Tool. See the example of an incorrect/incomplete signature circled below.
- If you make a mistake, you can clear out the signature by right-clicking and selecting Clear Signature, as shown below.
- Refer to your organization’s internal policies regarding electronically signing on behalf of another individual if they are unable to sign themselves.
- The COVID-19 Vaccinator Enrollment Tool has detailed Completion and Signature Instructions to help you electronically sign the forms using Adobe Acrobat DC.
- You must also add a date in YYYY-MM-DD format.
- A date and time stamp will appear if the signature is properly completed. See the example of a correct signature circled below.
If you have any challenges when completing the process, send an email to DHSCovidVaccinator@wi.gov with the subject line “Vaccinator Enrollment Forms” to request a video call to troubleshoot any issues.
- When you are ready to submit your forms, upload the form(s) that were electronically signed to the COVID-19 Vaccinator Enrollment Tool.
- Click the Submit Forms hyperlink, located on the blue bar at the top of your web browser.
- You can upload up to one form for Part A, five forms for Part B, and one Redistribution form.
- To upload the form(s), click inside of the box of the type of form you would like to upload (as shown in the screen shot below).
- A browser window will pop up; navigate to where you saved a copy of the completed form.
- Select the file that you would like to upload, then click Open.
- Once all the files that you want to upload appear in the relevant boxes, click the blue Upload Files button, shown below.
- You will see a confirmation screen (shown below) when your forms have been uploaded successfully. If for some reason you are unable to upload the form(s), please email a copy of the completed form(s) to DHSCovidVaccinator@wi.gov.
- A DHS representative from the quality assurance team will contact you within 1-2 business days if there are any issues with the information provided on your forms.
- At different stages of registration, DHS may contact you to ask questions about your submission, correct errors, or provide instructions on the next steps. Please respond to this outreach immediately so that DHS can continue processing your registration.
Once your forms are submitted, your information is verified, and your WIR account is configured, the primary and backup contacts listed on Form B will receive an email from DHS with the next steps for your organization. The email will include links to important materials to share with vaccine recipients, as well as instructions and a link to complete the online Training Attestation and Readiness Checklist survey. If you would like to begin training staff before you get the link to the online Training Attestation and Readiness Checklist survey, you can view the printable COVID-19 Vaccinator Training and Readiness Checklist, P-03269.
Once the Training Attestation and Readiness Checklist survey has been submitted online, your location is considered fully enrolled and may order and administer COVID-19 vaccine. See the DHS ordering process steps.
Vaccination sites must maintain their Vaccines.gov profile. Vaccines.gov is the tool that the public uses to find COVID-19 vaccines near them and other important information.
Please refer to the Vaccines.gov provider resources webpage for instructions on managing your profile. Vaccinators are encouraged to manage the following Vaccines.gov public-facing information for each site:
- Whether a site is publicly displayed or not
- Website information
- Phone number
- Minimum vaccination age
DHS reports daily inventory data to Vaccines.gov and will continue to provide vaccine type and in-stock inventory data on behalf of vaccinators. Vaccinators only need to maintain their profile.
How to get started with Vaccines.gov
- After completing enrollment, your location’s organizational contact (as indicated under Form A of the Provider Agreement) should receive an email from email@example.com. This email provides instructions to complete the Vaccines.gov registration process using the COVID Locating Health Provider Portal. This invitation will expire after 7 days.
- Answers to frequently asked questions and other instructions are available through the Vaccines.gov Provider Resources page.
- If you cannot locate the email from firstname.lastname@example.org, or you need further assistance after reviewing the guide, please email DHSCovidVaccinator@wi.gov.
- The initial registration invitation is sent to the organization email listed under part A of the Provider Agreement. If any of your organization and coordinator emails are incorrect, please email DHS at DHSCovidVaccinator@wi.gov to request any necessary updates.
- When you register with Vaccines.gov, you can set up the reporting structure for your organization. There are two options:
- Under the organizational-level maintenance setup, the Part A contact would be required to manage the details for the public profiles of all locations.
- If the organization wishes to delegate the control of profile information to each location, they should set site-level maintenance:
- If the organization contact designates site-level reporting, this triggers registration emails to be sent to the site-level vaccine coordinators listed in section B of the Provider Agreement.
- After registration is completed, the coordinators for each location would be able to log in independently and manage details for that specific location.
- Once registered in Vaccines.gov, you will be responsible for managing the public display information for your locations on Vaccines.gov through the portal. To begin, check your public display details to make sure the information is accurate.
- Providers have the option of uploading a spreadsheet or filling out a manual form to update their public display information. Guides for each option are below:
- Upload file - typically used by providers who are reporting for a large number of locations.
- Log manually - typically used by providers who are reporting for a small number of locations.
- Please note, vaccinators will not be able to update their inventory settings, location names, or addresses. To make changes to inventory setting, location name, or address please email DHSCovidVaccinator@wi.gov with the subject VACCINES.GOV.
- For more information on Vaccines.gov, please see the Vaccines.gov provider resources webpage.
See the DHS COVID-19: General Guidance for Vaccinators webpage for best practices when updating your Vaccines.gov profile, including ensuring your profile is viewable and indicating the minimum age of patients eligible for vaccination at your location.
Enrollment questions and answers
For more information about the Wisconsin Immunization Registry (WIR), visit their website or contact the WIR Help Desk by phone 608-266-9691 or email.
Q: Who needs to do the WIR training?
A: With having access to WIR data and ensuring timely and accurate information, comes the need for a solid understanding of how to utilize the various components of WIR and how they work together. Any staff responsible for data entry into WIR for the daily management of inventory and/or updating client (patient) records to record the administered dose are required to review the training material. Staff that are only administering vaccine and will not be responsible for the data entry and management do not need to be concerned with the training.
Q: What does the WIR training entail?
A: WIR training includes the following topics:
Client look up and entry of doses, including mass vaccination module
Inventory management, including reporting daily inventory
Use of bar code scanner
Reporting wasted doses
Q: What should I do if I can't access the WIR training related to COVID-19 enrollment?
A: Staff with existing IR Administrator access should be able to use the ‘Assign Training’ tool to provide their staff with the training modules.
If you are using a web browser other than Internet Explorer (IE), you may encounter issues with this.
Q: How do I enroll?
A: Please follow the steps outlined in the Steps to Enroll tab above. Once you generate your forms in the enrollment tool, there is hover text with additional details located in the blue bars of your forms. When you hover your mouse over some of the blue section bars, text boxes will pop up with further instructions.
Q: Should I enroll in the COVID-19 Vaccine Program if my organization is already a Vaccines for Children (VFC) and/or Vaccines for Adults (VFA) provider?
A: Yes, you need to enroll. This is a new program and all providers need to sign the CDC COVID-19 vaccine agreement regardless of VFC or VFA status. If administering the COVID-19 vaccine children between 6 months through 11 years, you must attest to an additional set of age-specific training certifications listed above.
Q: Is there a certain web browser I must use for the enrollment tool?
A: Yes, please use Google Chrome. Do not use Internet Explorer or Microsoft Edge. If you do submit your forms in the wrong browser, you may get an error. If this happens, please regenerate the forms and resubmit them in Google Chrome.
Q: Where can I find additional instructions to complete the enrollment forms?
A: Additional instructions are provided as hover text over the blue bars within each of the forms. There are guides on how to fill out all provider enrollment forms in the COVID-19 Vaccine Enrollment Tool. These go over examples and expand on what is needed in each section of the forms.
Q: How do I electronically sign my agreement?
A: Complete the following steps:
Use Google Chrome to download the forms.
Save the forms to your desktop.
Complete your forms electronically in the updated version of Adobe Acrobat Reader DC. If you use an earlier version, it will let you sign and complete your form, but the PDF produced from it may be too large to be accepted by the enrollment tool. Do not complete the forms in a web browser, such as Internet Explorer.
Follow the instructions found in the enrollment tool to upload your forms and complete your signature.
Q: How do I know what the next steps are after I submit the enrollment forms?
A: Once the forms have been successfully submitted, they will go through a review process and be matched to an existing WIR account. Throughout this process the provider enrollment group will be reaching out to correct forms, ask questions about your forms, and set you up with a WIR account if none exist for you. You will also receive an email with next steps, including a training attestation and readiness checklist survey that need to be filled out and returned to be considered fully enrolled.
Q: Should Vaccines for Children (VFC) providers enroll in the CDC COVID-19 Vaccination Program?
A: Yes, as Emergency Use Authorization of COVID-19 vaccine products expand to include adolescents and children, providers enrolled in the Vaccines for Children (VFC) Program are well situated to enroll in the CDC COVID-19 Vaccination Program to ensure equitable access to COVID-19 vaccination services. VFC providers have direct access to the younger patient population and are familiar with vaccine administration and federal vaccine programs. If you do not receive communication from an enrollment team member within two or three business days of submitting your forms, please email DHSCovidVaccinator@wi.gov.
Though the VFC and COVID-19 Vaccination programs are both federal government programs, they each have distinct requirements based on the associated funding legislation. For this reason, the provider agreements remain separate, and VFC providers must sign and adhere to the requirements of the CDC COVID-19 Vaccination Program Provider Agreement in order to receive and administer COVID-19 vaccines.
Review CDC's website, Vaccines for Children Program vs. CDC COVID-19 Vaccination Program, to assist in understanding the differences in the programs’ requirements.
Q: How many Form A's need to be submitted?
A: Only one Form A needs to be submitted for the entire organization. However, a Form A may be submitted for any level of the organization from the clinic all the way up to the corporate level.
Q: Which sites in my organization need to fill out the Form B?
A: Complete one Form B for each site that will be administering COVID-19 vaccine.
Two-day vaccine clinics (less than 48 hours) and their second dose clinics one month later do not need a Form B. However, if vaccine is stored over night or held for more than two consecutive days, a Form B is necessary for that location.
There may be special conditions in which single- or two-day vaccine clinics need a Form B. These provider registration scenarios determine whether an additional Form B is required for a vaccination clinic.
If you are unsure whether you need a Form B, you can preemptively fill out a Form B or email DHSCovidVaccinator@wi.gov for clarification.
Q: Is there a limit to how many Form B’s can be filled out for every Form A?
A: No, there is no limit. If you are going to submit multiple Form B’s for one Form A, please create a different organization location name for each clinic’s Form B so they can be matched to the correct WIR site. All of the forms will still need to have the same reference number and organization's legal name listed at the bottom of their Form A.
Q: What if sites begin submitting Form B’s before the organization’s Form A is submitted?
A: Form B’s will not be registered until the corresponding Form A is verified. Once both sections are submitted and verified, the organization and sites will begin the WIR matching process.
Q: Which providers should be included on my Form B?
A: Any provider licensed in Wisconsin who has prescribing authority or who will have oversight of the handling or administration of COVID-19 vaccine should be included on your Form B’s. This includes titles such as MD, DO, NP, DPM, PA, RPh, and more. Please do not list providers who will be immunizing without prescribing authority, such as EMT, RN, LPN, paramedic, and others.
Q: If additional sites are identified after my original submission, can I submit additional Form B’s at a later date?
A: Yes, please make sure your organization name and reference number on the new Form B’s match your originally submitted forms.
Q: What if I don’t know my IIS identifier?
A: Please include either:
Your Wisconsin Immunization Registry (WIR) Org ID. If you do not know your WIR Org ID, you can use the following steps to find your WIR Org ID, if you have one.
Find a staff member from your organization that has access to WIR as an IR Administrator. Any staff member that is an IR Administrator can find your WIR Org ID by following these steps.
Navigate to manage access and select Edit Organization.
From the list of organizations click the link for the correct location.
The Edit Organization page loads.
You will find a number next to the Org Id. This number is also your IIS Identifier.
If you cannot find or do not have your WIR Org ID, you can use your VFC PIN.
If you do not have a WIR Org ID nor a VFC PIN, then please submit your forms without them.
Q: I have signed the forms incorrectly and when I submitted it, I got an error. I fixed the signature (per the Signature Instructions), and the enrollment tool still will not accept my forms. What should be done?
A: Unfortunately, you will need to generate a new version of the forms, complete the fields again, sign it correctly, and then resubmit it to the enrollment tool.
Q: What if I need to update information on the forms?
A: Please submit an email request to change information to your forms to DHSCovidVaccinator@wi.gov. You must include the location or organization name listed on your original forms in the subject line. Then include what information you need changed in the body of the email.
Q: When will I know if my forms were submitted correctly?
A: After your forms have been submitted, you should receive a confirmation screen which will indicate that your forms have been submitted correctly. You do not receive an auto-generated email; however, an enrollment team member should contact you within two or three business days. Please email DHSCovidVaccinator@wi.gov to follow up on the status of an application.
Q: How do I add additional health care providers (licensed clinicians) to my Form B that has already been enrolled?
A: Please email DHSCovidVaccinator@wi.gov to request a template for the additional providers’ information. In the subject line please add, “Additional Providers for Form B.”
As a reminder, all licensed health care providers who have prescribing authority or who will have oversight of the handling or administration of COVID-19 vaccine must be listed on the site’s Form B. This includes titles such as MD, DO, NP, DPM, PA, RPh, and more. Please do not list providers who will be immunizing without prescribing authority, such as EMT, RN, LPN, paramedic, and others. Only licensed providers with direct involvement with COVID-19 vaccine should be listed.
Jump to top of page.