Seasonal Flu Vaccinations Request Form Please complete the details below to request a flu vaccine voucher. Once the completed form has been received it will be processed and a voucher will be sent out to you within 48 hours. For the employee to complete: Employee Name:
Employee Number:
Department: Address for the voucher to be sent to (can be home or work) Signed:
Date:
Please ensure that you state the full address in order to minimise any delay in receiving your voucher
HR use only Received:
Voucher sent: Date:
Y
N
Date sent: Signed:
Date:
Print name: This form needs to be returned to the HR Department, Southgate Campus, High Street, London N14 4BS to be processed or it can be scanned and emailed to Charleene.Davies@barnetsouthgate.ac.uk.