To request an exemption from required vaccinations, please complete the form below and return this form to the human resources department.
| Name (print): | Date: |
| Dept.: | Position: |
| Manager: | Work/Cell Phone: |
I am requesting a religious exemption from [Company Name]'s mandatory vaccination policy for the following vaccination(s):
Please describe the nature of your sincerely held religious beliefs or religious practice or observance that conflicts with the vaccination requirement:
_______________________________________________________________________
_______________________________________________________________________
Please provide any additional information that you think may be helpful in reviewing your request. For example:
- How long you have held the religious belief underlying your objection.
- Whether your religious objection is to the use of all vaccines, a specific type of vaccine or some other subset of vaccines.
- Whether you have received vaccines as an adult against any other diseases.
_______________________________________________________________________
_______________________________________________________________________
I verify that the information I am submitting to substantiate my request for exemption from [Company Name]'s vaccination policy is true and accurate to the best of my knowledge. I understand that any falsified information can lead to disciplinary action, up to and including termination.
I further understand that [Company Name] is not required to provide this exemption accommodation if doing so would pose a direct threat to myself or others in the workplace or would create an undue hardship for [Company Name].
| Employee Signature: | Date: |
HR USE ONLY
Date initial received: __/__/____ Date any additional documentation received: __/ __/ ___
Accommodation request:
- Approved __/__/____
Describe specific accommodation details:
______________________________________________________________________
- Denied __/__/____
Describe why accommodation is denied:
______________________________________________________________________
An organization run by AI is not a futuristic concept. Such technology is already a part of many workplaces and will continue to shape the labor market and HR. Here's how employers and employees can successfully manage generative AI and other AI-powered systems.
Related Content
HR must always include human intelligence and oversight of AI in decision-making in hiring and firing, a legal expert said at SHRM24. She added that HR can ensure compliance by meeting the strictest AI standards, which will be in Colorado’s upcoming AI law.
The proliferation of artificial intelligence in the workplace, and the ensuing expected increase in productivity and efficiency, could help usher in the four-day workweek, some experts predict.
Learn how Marsh McLennan successfully boosts staff well-being with digital tools, improving productivity and work satisfaction for more than 20,000 employees.