Religious and Medical Vaccine Mandate Sample Forms

Questions on exemptions from the mandate?

According to the proclamation, "employees must show proof of vaccination by October 18, 2021. State employees may work with their agency’s human resources office if they need a reasonable accommodation for medical or religious reasons. Private sector employers may choose a different process."

Medical exemptions would be handled through the Reasonable Accommodation process in compliance with the Americans with Disabilities Act (ADA) and with your agency's designated human resource staff. If you have a medical accommodation and find you need help after reaching out to your agency's HR, please contact us and we would be happy to assist you through the process.

Sample form: Check out this Sample Vaccine Proclamation Medical Questionnaire Template for guidance.

Religious exemptions are also expected to be handled through your agency's designated human resource staff. However, it is not handled through ADA, but rather the Equal Employment Opportunity Commission (EEOC) criteria for a legitimate religious exemption. These guidelines are not yet clear and are likely to be part of the bargaining process regarding impacts of this mandate. 

Sample forms: Here are two sample requests & guidance for employees and HR on filing religious exemption requests:

Need more information on the COVID-19 vaccine mandate?

Our union is here to support. Check out our FAQ page for information on our union's stance on the mandate, how we are using our collective bargaining power on behalf on members' safety and rights, and more.