Westchester Restaurants Pre-Vaccination Survey

For restaurants and food service providers in Westchester County only

[Hoteliers please click here to access the separate survey for accommodation providers.]

New York State recently added restaurant workers to the list of those eligible for COVID-19 vaccinations in “phase 1B,” if supply allows.

The county executive requests all restaurateurs' help to prepare for a streamlined process. We're preparing a count of interested and eligible restaurant workers, and a list of restaurants and their management contacts – with whom the County Health Department can coordinate scheduling, once further guidance comes from the state and more vaccine doses arrive from the federal government.

As you complete this brief survey, please note that at this point, only workers at least 18 years old -- who have not already received a COVID-19 vaccination -- should be included in your count of employees willing to be vaccinated. We do not need employees’ names at this time, just a count and a designated contact person.

Any questions or comments? Note them in the space provided below, or call us at (914) 995-8500.

Thank you.

Pre-Vaccination Survey

Restaurant/Company Name*:

Single/Multiple Locations*:

Please indicate above whether this response covers an individual location or a restaurant group encompassing multiple locations.

Street Address*:

City*:

County*:

State*:

Zip Code*:

Contact Person - First Name*:

Contact Person - Last Name*:

Contact Person - Job Title*:

Contact Person - Telephone*:

Contact Person - Email Address*:

Total # of Employees*:

Number Wanting Vaccination*:

NOTE: The "Number Wanting Vaccination" provided above should NOT include employees who have already received a COVID-19 vaccination. All prospective vaccine recipients must be at least 18 years of age.

Comments or questions (optional):

* Indicates a required field.