Ingalls is coordinating with Singing River Hospital System (SRHS) to make COVID-19 vaccine available to Ingalls employees, their dependents (18+), contractors and local customers (U.S. Navy & Coast Guard) who want to get vaccinated.

Please provide:

Information

Last Name

First Name

Cell Phone

Are you an Ingalls employee?

Badge Number:

If you are not an employee, enter zero in this field.

If not an employee, please select which best describes your affiliation to Ingalls Shipbuilding:

You will not receive an appointment confirmation. Please arrive at the vaccination facility at your selected time.

STEP 1: COVID-19 Vaccine Eligibility

All Ingalls Shipbuilding employees, their dependents (18+), contractors and local customers (U.S. Navy & Coast Guard) are eligible to receive the vaccine at this time.

Even if eligible, SRHS may deny or delay your vaccination request unless you confirm that ALL of the statements listed below are true and correct and remain true and correct on the day of your vaccine appointment:

I do NOT have a history of severe allergic reactions including from any prior injectable medications or vaccines
I have NOT received any other vaccine within the past two weeks
I have NOT received monoclonal or antibody therapy for COVID-19 in the previous 90 days
I have NOT tested positive for COVID-19 in the previous 14 days
Pregnant women, lactating women and those who are immunocompromised may take the vaccine; however, consultation with your healthcare provider is recommended.

I confirm that all of the above statements are true and correct at this time and will remain true and correct on the day of my vaccine.

Yes, these statements are true.One or more of these statements are not true.

Thank you for your interest in receiving the COVID-19 vaccine, unfortunately, you are not eligible at this time. Please check back later.

STEP 2: Request a COVID-19 Vaccine Appointment

SRHS will administer vaccines during the times listed below. Choose the availability window most convenient to you and arrive during that time:

Please indicate your time preference for Thursday, April 15 below:

Early afternoon (12:30 - 2:30 pm)Late afternoon (2:30 - 5 pm)

You will not receive an appointment confirmation. Please arrive at the vaccination facility at your selected time.

By submitting this request for a 1st dose COVID-19 vaccine, I hereby certify the information provided in this request is true and that I meet the current MDoH eligibility criteria for vaccination.

I understand that I will have to sign a separate consent form provided by SRHS for it to administer the vaccine to me.

I will make every effort to attend my appointment and understand that failing to do so will require me to submit a new request (a “make-up” appointment will not be scheduled for me).

I understand that this request is for a 1st dose COVID-19 vaccine only. I understand that I do NOT need to request a 2nd dose COVID-19 vaccine appointment as the 2nd dose will be scheduled for me at the time I receive my 1st dose of the vaccine.

STEP 3: Certification

Do you understand the above statements?

Yes, I understand.