In 2006, California enacted SB 739 to add more regulation to existing laws providing for health care licensure and regulation by the Department of Health Services. This included providing employees with flu vaccinations, which if the employee declines, they must do so in writing (through a declination). The purpose of this study was to evaluate the possible effects of policy on health care workers in San Diego County through by evaluating the adoption of vaccination strategies and their outcomes. The San Diego Hospital Influenza Immunization Partnership (SDHIIP), a collaboration of representatives from nearly every San Diego County hospital working to improve immunization rates, provided the data used in this study. Health care worker immunization status and knowledge was surveyed through random digit dialing telephone surveys. Coverage rates and 95% confidence intervals were then calculated and compared. Overall influenza vaccination coverage rates among HCWs did not fluctuate significantly in the 2006, 2007, or 2008 flu season. The exception for non-SDHIIP hospitals from 2007 and 2008 flu season when coverage rates slightly increased from 57.2% (95% CI = 54.1, 60.3) to 82.4% (95% CI = 61.3, 100). Influenza coverage based on demographics is consistent with past literature. Data demonstrated an increased recall of influenza promotion activity used by employers and several influenza promotion activities which were associated with positive increases in influenza vaccination rates. This study found that for HCWs in San Diego County, demographic characteristics associated with influenza coverage were consistent with findings in the current literature on influenza vaccinations. The SDHIIP program and state SB739 mandate appear to have been effective in increasing employer influenza vaccination promotion practices. Unfortunately, it does not appear that policy targeting greater knowledge and increased access to vaccination translates into greater HCW perceived need or significantly higher influenza vaccination rates. Overall, study suggests that mandates for declinations alone are not enough to increase coverage rates of healthcare workers and that mandates for influenza vaccinations may be required.