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COVID-19 Vaccination: Medical Exemption/Accommodation Request Form

Author: Kim Freeman, Freeman Legal Consulting, LLC

When to Use

If an employer implements a policy requiring employees to get the COVID-19 vaccination, an employee may request an exemption or a reasonable accommodation. An employee may be entitled to an accommodation that does not impose an undue hardship on the employer.

This form will help an employer obtain information from the employee when evaluating their medical exemption or accommodation request.

Customizable Form