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Medical Exemption Request – COVID-19 Vaccine

2021

This sample form was developed in connection with CAPLAW’s Vaccines and the COVID-19 Pandemic series of conversations. The template allows employees to request an exemption from an employee vaccination mandate and provide corroborating information and documentation. It also contains some recordkeeping questions that a CAA might use to standardize and document its process of providing reasonable accommodations. CAPLAW recommends adapting this form to meet the needs of your agency in consultation with local counsel in your state.

Related Resources:

Webinar on Federal Vaccine Mandates Compliance Guide

Webinar on Federal Vaccine Mandates Compliance Guide

CAPLAW recently issued a step-by-step compliance guide to help the Community Action network navigate the employee vaccination mandates announced by OSHA, Head Start, and the Centers for Medicare & Medicaid Services (CMS). In this resource we describe the planning...

Mandatory Vaccination Policy Template

Mandatory Vaccination Policy Template

This Mandatory Vaccination Policy requires all employees to be fully vaccinated against COVID-19. This policy does not offer employees the option to undergo weekly COVID-19 testing and masking in lieu of getting vaccinated, except as part of a reasonable accommodation for...

Federal Vaccine Mandates: Compliance Guide

Federal Vaccine Mandates: Compliance Guide

This step-by-step compliance guide is intended to help the Community Action network navigate the employee vaccination mandates announced by OSHA, Head Start, and the Centers for Medicare & Medicaid Services (CMS). We describe the planning process your CAA should consider as you develop and update your policies to reflect the new requirements.