Background: Maintaining a complete vaccination status for health-care workers (HCWs) is important to minimize morbidity among staff and patients. Despite recommendations from public-health authorities to support this process, not all hospitals have adequate policy and practice in place. Aims: To independently assess the implementation and impact of a new policy aimed at improving HCW vaccination coverage in a tertiary Victorian hospital. Methods: Two cross-sectional surveys were conducted by telephone in July and October 2000 for a random sample of HCWs, before and after the introduction of the policy. These surveys examined knowledge, attitudes and practices surrounding vaccination and self-reported vaccination status. Policy implementation was assessed by ascertaining completion of compulsory vaccination status forms and attendance at suggested appointments to review vaccination status. Results: Only 19% of 269 HCWs reported a complete vaccination status at baseline. Most (76%) had not heard of or seen vaccination guidelines and 39% kept written vaccination records. This was despite a belief in the importance of vaccination (94%) and a willingness to update if necessary (96%). At follow up there was no improvement in any outcome. Only 11/26 (42%) newly employed HCWs surveyed received and returned compulsory vaccination status forms. Of the few HCWs who attended recommended vaccination appointments, all received vaccinations. Conclusions: HCW vaccination coverage and knowledge of vaccination requirements were poor. Although attending a physician to discuss vaccination status did result in vaccination, few HCWs made such an appointment. While policy development is an important first step towards improving vaccination coverage, effective implementation requires ongoing evaluation, adequate resources and HCW education.