Dunn County Health Department

doh@co.dunn.wi.us

3001 US Highway 12 East Suite 032 Menomonie, WI 54751

715-232-2388

Non-Medical Essential Service Vaccination Waiting List

If your business provides non-medical essential services, please complete this form to be put on a waiting list. When vaccines are available we will contact you to make arrangements for your essential service workers to receive vaccinations at no cost. Please have only one person complete this form.

Non-Medical Essential Service Business Information

Business Name

Contact Person

Full Address

Street Address

City

State

Zip

Phone Number

Email

Business Sector

First Responders (e.g. Firefighters, Police Officers)

Corrections Officers

Food and Agriculture Workers

U.S. Postal Service Workers

Manufacturing Workers

Grocery Store Workers

Public Transit Workers

Education Sector (Teachers and Support Staff)

Child Care Workers

Number of Non-Medical Essential Service Employees

At this time we are not taking individuals on a waiting list, only businesses.

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