Readiness Assessment Tool

Health Center COVID-19 Vaccine Program
Readiness Assessment User Guide
This user guide is intended to assist you in completing the Health Center COVID-19 Vaccine Program
Readiness Assessment (RA) located in the Health Center COVID-19 Vaccine Program Online Community.
This assessment helps BPHC determine the readiness and interest of HRSA-supported health centers
preliminarily identified by CDC and HRSA to receive a direct allocation of a limited supply of COVID-19
vaccines as part of the Health Center COVID-19 Vaccine Program. One Vaccine Program Online
Community (VPC) user from your health center organization must submit this RA within the VPC to
participate in the program. The RA may only be submitted once, and must be completed in one sitting.
Information for individual sites that will participate in the program will also need to be completed in one
sitting. Please collect all the necessary information before you start the RA by reviewing what is
required.
For any issues completing the Readiness Assessment, please use the form under Contact BPHC on the
VPC to contact us for help.
Readiness Assessment Part 1 of 2: The first eight (8) questions, available under the Readiness
Assessment tab in the VPC, assess general health center readiness and must be answered fully in one
sitting.
Question Field

Instructions

1. If you were to receive a direct allocation of Select Yes or No based on your health center’s current
the COVID-19 vaccine starting the week
after next (amount TBD), can you ensure
that you can safely store the vaccine, and
that you have trained and credentialed
staff and sufficient Personal Protective

capability.
If you answer No, you will see this follow-up question:
1a. Would you be interested in the near future (e.g., 1 to 2
weeks) of receiving a direct allocation of COVID-19 vaccine

Equipment (PPE) to administer the vaccine

through this program?

in a timely manner?

Select Yes or No.
If you answer Yes, you will be asked to contact BPHC when
you are ready to receive a direct allocation via the
"Contact BPHC" section of the Online Community.
If you answer No to Question 1 or 1a, you are finished with
the assessment at this time. HRSA understands you are
opting out of the Health Center COVID-19 Vaccine
Program at this time. Please contact BPHC using the BPHC
Contact Form (also under “Contact BPHC” in the Online
Community) if your health center’s situation changes and

February 22, 2021

Question Field

Instructions
you want to participate in the Health Center COVID-19
Vaccine Program.

2. Are you currently receiving COVID-19
vaccines from the state?

Select Yes or No based on whether your health center is
currently receiving COVID-19 vaccines from your state.
This information is for HRSA and CDC awareness. Your
answer will not affect the COVID-19 vaccine doses you
may request under the Health Center COVID-19 Vaccine
Program. (See Planning Assumptions in the Readiness
Assessment tab of the Online Community.)
If you answer Yes, you will see this follow-up question:
2a. If so, what is the weekly allocation? (Enter number of
doses per week.)
In the field, please enter the number of doses your health
center is currently receiving from your state per week.
Enter numerals only; no text.

3. Where do you currently report data on

Click the checkbox for every means through which your

COVID-19 vaccine administration and

health center is reporting data on COVID-19 vaccine

outcomes? (Select one or more from the

administration.

following.)
•

Electronic health records

•

State's Immunization Information
System

•

Vaccine Administration
Management System

•

Vaccine Adverse Event Reporting
System (VAERS)

•

HRSA Health Center COVID-19
Weekly Survey

•

Other

If you select Electronic health records (EHR), a field will
appear for you to Enter Vendor Name. Please enter the
name of your EHR vendor.
If you select State's Immunization Information System (IIS),
a field will appear for you to Enter IIS Name. Please enter
the name of your state’s IIS.
The Vaccine Administration Management System (VAMS)
is an official CDC online application.
The Vaccine Adverse Event Reporting System (VAERS) is an
official program co-managed by CDC and FDA.
The HRSA Health Center COVID-19 Weekly Survey is a
voluntary survey sent by HRSA weekly.
Note that completion of this weekly survey, with additional
Vaccine Program questions, is mandatory for health

February 22, 2021

Question Field

Instructions
centers participating in the Health Center COVID-19
Vaccine Program beginning February 26, 2021.
If you select Other, a field will appear. Please enter a brief
explanation for choosing this option.

4. Do you have standing meetings with your
state or local department of health
contact to discuss vaccine administration

Select Yes or No according to whether your health centers
has regularly scheduled meetings with your state or local
department of health for this purpose.

and related lessons learned and
challenges?
5. Do you have a vaccine coordinator (and

Visit Section 5 of the CDC Playbook PDF document for

back-up coordinator) supporting your

more information about the role and expectations of a

center and service delivery sites?

vaccine coordinator.

(Note: A vaccine coordinator is the POC for
receiving vaccine shipments, monitoring
storage unit temperatures, managing
vaccine inventory, etc. See Section 5 of CDC
COVID-19 Vaccination Program Interim
Playbook for more information.)

Select Yes or No for whether your health center has a
specific person to perform this role, as well as a back-up in
case your primary vaccine coordinator is unavailable.
Your vaccine coordinator should be able to support your
health center and all service delivery sites you enroll under
the My Sites tab in a later part of this Readiness
Assessment.

6. Does your health center have a

Select Yes or No for whether your health center has the

process/system in place to schedule and

ability to schedule and manage vaccination appointments

manage COVID-19 vaccination

and reminders for patients.

appointments and reminders?

If you answer Yes, you will see this follow-up question:
6a. How will you get patients back for their second dose?
Do you have a reminder/recall system available?
In the test field, please answer how your health centers
plans to get patients to return for their second vaccine
dose.

7. If this direct allocation program allows for
redistribution of vaccines across service
delivery sites, do you have an effective
process for inventory management and

February 22, 2021

Select Yes or No according to whether your health center
would be able to effectively manage redistribution of
vaccine across your service delivery sites.

Question Field

Instructions

distribution of vaccines to service delivery
sites in place?
8. To administer the COVID-19 vaccine to
hard-to-reach, difficult-to-find patients
disproportionately impacted by COVID-19,

Select Yes or No according to whether your health center
has a plan for administering vaccine to hard-to-reach
patients.

do you have a plan for vaccine transport
(e.g., for mobile vaccination sites to reach
farmworkers, rural residents, etc.)?

Readiness Assessment Part 2 of 2, My Sites: Under the “My Sites” tab, provide information for each
proposed site to participate in the vaccine program, and enter site details. This federal direct allocation
program will complement state and jurisdiction allocation programs. Once you begin entering
information for an individual site, you must complete all the information for that site in one sitting. All of
your sites will be listed (the default is to show you sites that have NOT been proposed for this program
yet). Sites list were pulled from your health center's Form 5B, and is filtered to remove administrativeonly and mobile sites. You can identify sites from the list by Organization Name, BPHC Site ID, and
address.
To access the details page for a site, click on the Organization Name for that site
From the site details page, click the pencil icon by any editable field to edit any field in the site form.
Here is guidance on editing the site details:

Question Field

Instructions

Propose for Direct Allocation Program? (Click the > to the left of the title to expand this section if
necessary.)
Propose for Direct Allocation
COMPLETE THIS STEP LAST IF YOU ARE
PROPOSING THIS SITE FOR DIRECT VACCINE
ALLOCATION.

If you are NOT proposing to include a site for direct vaccine
allocation, select No and Save the form (bottom center Save
button). You are finished with this site and should return to
the My Sites list to complete information for another site.
You do not need to enter details for sites you choose to
exclude from this direct vaccine allocation.

This is a mandatory field.

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Question Field

Instructions
If you DO want to propose this site for direct vaccine
allocation, select Yes and save the form AFTER editing the
rest of the editable fields.
Once you select Yes for this field and Save the form, all
fields will lock and you will not be able to edit them.

Site Information (Click the > to the left of the title to expand this section if necessary.)
Rec’d COVID-19 Vaccines from State?
This is a mandatory field.
State/Jurisdiction Site VTrckS PIN
This is a mandatory field.

Select Yes or No for whether this site has received COVID19 vaccine doses from the state or jurisdiction.
Select Yes, No, or Not Sure for whether this site currently
has a state/jurisdiction VTrckS PIN from CDC.
To participate in the HRSA Health Center COVID-19 Vaccine
Program, health center sites will be assigned new federal
VTrckS PINs to allow orders from the federal allocation. If a
selected site does not have an existing state/jurisdiction
VTrckS PIN, please contact your local or state Immunization
Program Manager. Your state Primary Care Association
(PCA) may also be able to assist in finding this information.
Note that it may take longer than one week to send direct
allocations to sites without existing PINs.

Address Information – This must be a valid shipping address for this site. (Click the > to the left of the title
to expand this section if necessary.)
Site Street

Pre-populated from Form 5B.

This is a mandatory field.
Site Address Line 2
Site City

Pre-populated from Form 5B.
Pre-populated from Form 5B.

This is a mandatory field.
Site State
This is a mandatory field.

February 22, 2021

Pre-populated from Form 5B.

Question Field
Site Zip Code

Instructions
Pre-populated from Form 5B.

This is a mandatory field.
Site Address Correction

Confirm the accuracy of your site’s address including suite
or room number. If it is not accurate, please provide correct
address in the free text.

Address accurate for deliveries?

Please confirm that the site’s address above is accurate and
will allow for the receipt of vaccine deliveries. (Y/N)
If no, please provide a response to the next question.

Vaccine Shipping Address Correction

Use this text field to enter the correct address to receive
vaccine deliveries.

Special instructions for delivery

Use this text field to enter any brief instruction the delivery
person may need to complete this site’s vaccine delivery.
For example, if the delivery person needs to call ahead to
alert the point of contact, include that note.

Point of Contact (POC) Information – This information is for the person who will receive the “Welcome”
email from VPoP to provide portal access, and place vaccine orders. Once VPoP accounts are created, each
health center may update and add POCs based upon operational needs and preference. (Click the > to the
left of the title to expand this section if necessary.)
Site VPoP POC First Name

Enter the first name of this site’s point of contact.

This is a mandatory field.
Site VPoP POC Last Name

Enter the last name of this site’s point of contact.

This is a mandatory field.
Site VPoP POC Email
This is a mandatory field.
Site VPoP POC Phone Number
This is a mandatory field.

Enter a valid email address for this site’s point of contact.
Please check carefully for accuracy.
Enter a valid phone number for this site’s point of contact.
Please check carefully for accuracy. Only enter numerals,
not dashes or parentheses.

February 22, 2021

Question Field

Instructions

Hours for Accepting Vaccine Deliveries – Sunday through Saturday (Click the > to the left of the title to
expand this section if necessary.)
Closed / Can’t Accept Deliveries [day]

Leave the check box empty if this site is able to accept
vaccine deliveries that day.
Click the checkbox if this site cannot accept vaccine
deliveries on that day.
If you check this box, do not complete any of the Time fields
for that day.

[day] Open Time

Select the time this site can begin to accept vaccine
deliveries on that day.
Leave blank if the site is not open for vaccine deliveries on
that day.

[day] Close Time

Select the time this site can no longer accept vaccine
deliveries on that day.
Leave blank if the site is not open for vaccine deliveries on
that day.

[day] Break Start Time

If this site has a break period during the day in which
vaccine deliveries cannot be accepted, select the break start
time.
If this site does not have such a break time, leave this blank.

[day] Break End Time

If this site has a break period during the day in which
vaccine deliveries cannot be accepted, select the break end
time.
If this site does not have such a break time, leave this blank.

When you have entered and verified accuracy of all information for a site, make sure you indicate “Yes”
to propose this site for direct vaccine allocation (the first field on the details page), and then click ”Save”
in the bottom center of the screen.
If you receive any error messages, you must fix the error before the form will save.
-

Check for any mandatory fields that are blank.

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-

Check for incorrect field information or characters.
Correct errors and click “Save” again.

If you did propose this site for direct vaccine allocation, the form will now be read-only, locked for
further editing.
You must return to the “My Sites” tab under Readiness Assessment in the Vaccine Program Online
Community to complete information details for each individual site you want to propose for direct
vaccine allocation.
To verify that you have successfully proposed a site, select ‘My Sites – Proposed’ from the drop-down
list under the ‘My Sites’ tab to make sure that site is listed.

Need help?
For any issues completing the Readiness Assessment, please use the form under the Contact
BPHC tab to contact us for help. Select “Health Center COVID-19 Vaccine Program”—the fourth
option on the “Health Center Program Questions” screen. Then select “COVID-19 Vaccine
Program Technical Questions.” You can also call Health Center Program Support at 877-4644772, option 2, 7:00 a.m. to 8:00 p.m. ET, Monday-Friday (except federal holidays).
Persons using assistive technology may not be able to fully access information in this document.
For assistance, please email [email protected] or call (301) 443-2796.

February 22, 2021