Application to add vaccines to existing local immunisation programme August 2020
Auckland Regional Public Health Service | firstname.lastname@example.org I www.arphs.health.nz/vaccinator Page 2 of 2
Please read the declaration and sign
• I understand that as programme manager I am responsible for ensuring that the procedures and resources
referenced in this application are in place when vaccinations are delivered.
• I understand that as programme manager I must promptly inform Auckland Regional Public Health Service
before any changes are made to the programme referenced in this application.
• I understand that this programme must comply with the requirements stated in the Ministry of Health
Immunisation Handbook, including current cold chain accreditation (refer to “Immunisation standards for
vaccinators and guidelines for organisations offering immunisation services” and “Authorised vaccinators
delivering a local immunisation programme”).
• I declare that all the information that I have provided is true and correct at the time of application.
Signature(s) of programme manager(s)
SEND YOUR APPLICATION FORM AND REQUIRED DOCUMENTS TO ARPHS
Post: Vaccinator Authorisation
Auckland Regional Public Health Service
Private Bag 92 605
IF YOU HAVE ANY QUESTIONS
If you need more information, refer to the Ministry of Health Immunisation Handbook. If you still need more
information, contact us.
Email email@example.com or phone (09) 623 4600 ext. 27091