Publication - Advice and guidance

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

Published: 24 Mar 2021

This protocol is for the supply and administration of AstraZeneca COVID-19 Vaccine (ChAdOx1-S [Recombinant]) to individuals in accordance with the national COVID-19 vaccination programme.

AstraZeneca COVID-19 Vaccine (ChAdOx1-S [Recombinant]) Vaccine National Protocol
Annex B: Practitioner authorisation sheet

Annex B: Practitioner authorisation sheet

AstraZeneca COVID-19 Vaccine (ChAdOx1-S [Recombinant]) Vaccine Protocol v00.01 Valid from: DDDDDD Expiry: DDDDDD

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


By signing this Protocol you are indicating that you agree to its contents and that you will work within it.

Protocols do not remove inherent professional obligations or accountability.

It is the responsibility of each practitioner to practise only within the bounds of their own competence and any appropriate professional code of conduct.

Template example

Person authorising on behalf of the Provider

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Note to person authorising on behalf of Provider

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 those practitioners authorised to work under this Protocol.