COVID-19 Vaccination Accommodation Request

Form/Letter / HR Compliance Health & Wellness ADA & Accommodations

This sample form can be used to request the need for a COVID-19 Vaccination accommodation due to a physical or mental disability. Employers can provide this form to the employee to have a physician or approved medical provider document the need for an exemption. The form can be modified to fit the needs of your organization.

Complete the form below and the resource will be emailed to you.