SELF CERTIFICATION FOR FULLY VACCINATED BUSINESSES

Getting vaccinated is the best way to prevent the spread of COVID-19. Proof of vaccination is becoming a common requirement at many establishments, and many employers are requiring that employees be fully vaccinated.

Please complete the following questionnaire to show your commitment to protecting Chicago by requiring proof of vaccination from patrons and employees. Please note that if your business qualifies for approved self-certification, this does NOT exempt your business from enforcement of city, state, and federal laws by government departments and agencies like indoor masking requirements.

If you qualify for self-certification, please post your self-certification badge in a prominent location at your place of work and on social media to show your support! #VaxChiNation

What is the legal name of your business or organization?

What is your DBA or assumed name for your organization?

Please fill out the address information for your business or organization.

Street address

Apartment, unit, building or floor number

City

State

Zip code

Is your business or organization woman-owned?

OPTIONAL QUESTION for analytical purposes only

Yes
No
No response

Is your business or organization minority-owned?

OPTIONAL QUESTION for analytical purposes only

Yes
No
No response

Is your business or organization veteran-owned?

OPTIONAL QUESTION for analytical purposes only

Yes
No
No response

Please enter your business or organization’s email.

Please enter your business or organization’s phone contact.

Intl code + 10 digit number

Please enter your first name.

Please enter your last name.

Please describe your role within the organization.

Have you reviewed the latest reopening guidance for Chicago?