COVID-19 Vaccine Religious Exemption Request

Health & Wellness
ADA & Accommodations

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XYZ Company respects the religious beliefs and practices of our employees. We are also subject to federal mandates that require employers to implement a mandatory COVID-19 vaccination and/or testing program. Employees who have a sincerely held religious belief that precludes them from obtaining a vaccination may request an exemption by requesting an accommodation. XYZ Company will review the request and consider reasonable accommodations, unless doing so poses an undue hardship.

Employees requesting an exemption from the COVID-19 vaccine due to a religious exemption should complete Section 1 below and submit it to Human Resources for approval.

COVID-19 Vaccine Bottle