Coronavirus (COVID-19) AstraZeneca vaccine (ChAdOx1-S [Recombinant]): national protocol

Protocol guidance for the AstraZeneca COVID-19 Vaccine (ChAdOx1-S [Recombinant]).

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Annex C: Clinical Supervision sheet

AstraZeneca COVID-19 Vaccine (ChAdOx1-S [Recombinant]) Vaccine Protocol

Valid from: Expiry:

This sheet must record the name of the clinical supervisor taking responsibility and all of the people working under different activity stages of the protocol.

Activity stages of the vaccination pathway under this protocol:

Stage 1 a. Assessment of the individual presenting for vaccination b. Provide information and obtain informed consent c. Provide advice to the individual Registered Healthcare Professionals Only
Stage 2
  • Vaccine Preparation
Registered Healthcare Professionals, non-registered professionals or non-registered Armed Forces staff
Stage 3
  • Vaccine Administration
Registered Healthcare Professionals, non-registered professionals or non-registered Armed Forces staff
Stage 4
  • Record Keeping
Registered Healthcare Professionals, non-registered professionals or non-registered Armed Forces staff

The clinical supervisor has ultimate responsibility for safe care being provided under the terms of the protocol. Persons working under the protocol may be supported by additional registered healthcare professionals, but the clinical supervisor retains responsibility.

Before signing this Protocol, check that the document has had the necessary authorisations. Without these, this Protocol is not lawfully valid.

Clinical Supervisor

Name
Designation
Signature
Date

Practitioner(s) and Activity Stages

Name
Activity Stage(s)
Signature
Date

Note to Clinical Supervisor

Score through unused rows in the list of practitioners to prevent practitioner additions post managerial authorisation.

This authorisation sheet should be retained to serve as a record of clinical supervision arrangements for those working under this Protocol.

Contact

Email: CEU@gov.scot

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