COVID-19 Vaccination Exemption Form In their letter to Texas employers about Executive Order GA-40, the Texas Workforce Commission created a sample form that can be used to request an exemption from an employer's vaccine requirement. ( All states and the District of Columbia allow a medical exemption. ( The Equal Employment Opportunity Commission (EEOC)enforces federal employment discrimination laws in the U.S. Source: Texas Administrative Code Rule 97.66/69. This news article from the Texas Tribune explains the recent legislation restricting "vaccine passports" in Texas. ) or https:// means youve safely connected to the .gov website. subject to the reasonable accommodation provisions of Title VII and the ADA and other EEO considerations discussed below. An employer may need to offer reasonable accommodations for employees who aren't able to be vaccinated due to a disability or certain religious belief: There are several federal COVID-19 vaccine requirementsfor different types of workers. You can even upload documents for an attorney to review. ( Standard Forms (SF) Privacy laws preclude health care providers from disclosing private and confidential medical information to anyone without authorization. It is TFVCs recommendation, however, that you submit the official exemption affidavit when applying since some might not be familiar with the law. The DSHS Immunization Branch website: https://corequest.dshs.texas.gov/. Equal Employment Opportunity Commissions. COVID-19 Vaccinations and Your Employment, Digital strategy, design, and development by. This is a list of all GSA forms. ( This emergency temporary standard (ETS) from the Centers for Medicare & Medicaid Services requires covered employees to get vaccinated for COVID-19. ( It also prohibits businesses that receive public funding or state licensing from requring proof of COVID-19 vaccination status in order to obtain service. 2. Parents or guardians will then have to sign the form in front of a notary public. For the COVID-19 vaccine, personal conscience may also qualify one for an exemption. ( You can remove yourself and your children from ImmTrac by using the ImmTrac Withdrawal Form/Withdrawal of Consent and Confirmation Form. You can find more ways to file a complaint and more information on the complaint-reporting processhere. ( No other forms, photocopies or reproductions are valid. In this instance, two different documents will be needed. ( Does this new vaccine exemption option mean that my vaccinated child may be attending school with other children who are not fully vaccinated? Persons who can prove that they are serving on active duty with the armed forces of the United States are exempt from school vaccination requirements. Can my employer require me to get the COVID-19 vaccine before physically returning to work? Copyright 2023 Texans for Vaccine Choice, 1540 Keller Parkway Ste. 2105 to be vaccinated against COVID-19, with exceptions only as required by law. ( Note At this time, the COVID-19 vaccine mandate for federal contractorshas been halted by a rulingfrom the Sixth U.S. The End Date of your trip can not occur before the Start Date. 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COVID-19 Testing Requirements ), duly registered and licensed to practice medicine in the United States who has examined the child. All affidavit forms will be mailed to you via U.S. ( The employee must cooperate with the employers reasonable inquiries or may not be entitled to an accommodation. Employees who are medically exempt may not be discriminated or retaliated against. ( To report violations of GA-40 to TWC, e-mail vaccine_job_loss@twc.texas.govor call (800) 939-6631. [2] The last version of Texas House Bill 155 proposed to expand the permissible exemption reasons to " (1) the individual's acquired immunity against COVID-19 through post-transmission recovery; (2) a medical condition; or (3) reasons of conscience, including a religious belief." a student who transfers from one Texas school to another and is awaiting the transfer of the immunization record (Note: dependents of a person who is on active duty with the armed forces of the United States do not have to transfer from a Texas school to qualify for provisional enrollment. Unless the exemption states a lifelong condition, the exemption is only valid for one year. However, your decision as to whether to get the COVID-19 vaccine is a personal one, and one that should be made after consulting with your health care provider. ( Please try again later. However, TFVC has received reports from members across the state that some facilities are choosing not to abide by this law and instead are denying exemptions. Looking for U.S. government information and services? Employee Signature Date . Some public junior colleges and community colleges may require students to use this option. If you choose to receive the COVID-19 vaccine, you should receive a vaccination card, which can serve as proof of your vaccine. All but three states offer nonmedical exemptions for religious or philosophical reasons. (e)AAThe commission shall develop and make available on the commission ' s Internet website a blank affidavit form to be used by an employee who claims an exemption from a required COVID-19 vaccination. Under the ADA, employers may be required to engage in a good-faith effort to determine if an employee seeking a medical exemption has a qualifying disability and can alternatively be protected from infection. ( You can file a complaint by e-mail to the attention of Manager, Immunization Branch at [emailprotected]. Please enter a valid phone number using an acceptable format. Can my employer ask about my medical history before requiring me to receive a vaccination? ( There are 3 places in the family code that specifically address this issue. If vaccination is voluntary, then the ADA requires that the employees decision to answer pre-screening, disability-related questions also must be voluntary. This is a list of optional government forms that start with the letters "OF". ;'! or D.O. Employers are not generally required to accommodate secular or medical beliefs about vaccines. The religious exemption on file remains valid. Your affidavit forms for hand-delivered requests will be mailed to you via U.S. DSHS recognizes, however, that for a small number of people, there may be valid medical reasons for which they cannot receive certain vaccines. What information will be listed on the vaccine exemption affidavit form I receive? ), registered and licensed to practice medicine in the United States, which states that, in the physician's opinion, the immunization required would be injurious to the child's health and well-being or to any of the child's family or household members. Dependents of service members are not excluded from Texas vaccination requirements. ( COVID-19 Vaccinations and Your Employment (TexasLawHelp.org), The EEOC Updates Guidance Clarifying Mandatory COVID-19 Vaccinations, Department of Labors Occupational Safety and Health Administration (OSHA), COVID-19 Vaccination and Testing; Emergency Temporary Standard, OSHA COVID-19 Vaccination and Testing ETS FAQ, Fact Sheet: Biden Administration Announces Details of Two Major Vaccination Policies (11/4/21), Executive Order on Ensuring Adequate COVID Safety Protocols for Federal Contractors, Safer Federal Workforce Task Force Vaccinations Guidance, New Guidance on COVID-19 Workplace Safety for Federal Contractors, Centers for Medicare & Medicaid Services (CMS), Medicare and Medicaid Programs: Omnibus COVID-19 Health Care Staff Vaccination, CMS Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule FAQ, Biden-Harris Administration to Expand Vaccination Requirements for Health Care Settings, guidance fromthe Safer Federal Workforce Task Force, Executive Order on Requiring Coronavirus Disease 2019 Vaccination for Federal Employees, Section 161.0085of the Texas Health & Safety Code, Texas Governor's Executive Order No. A vaccine exemption Affidavit is a document that is sworn by you and signed before a notary public (including a notary or a paralegal) in order to establish your request to be exempt from the COVID-19 vaccine. Our Legal Help guide has information on free legal hotlines, legal clinics, and legal aid organizations, as well as information on how to find a lawyer who could represent you. Employers considering such a mandatory vaccine should evaluate the potential implications of such adverse reactions, especially with a Covid-19 vaccine that will not have been time-tested when first available. %%EOF ( As librarians, we are unable to comment on whatconflicting state and federal orders and regulations mean for a given situation. Any child who utilizes the affidavit may be excluded from school in times of emergency or epidemic declared by the commissioner of public health. Even if the employee provides such information, the employer may deny the accommodation request if it would pose an undue hardship in the circumstances, or the employer may impose other infection control measures (e.g., mask requirement) if not done for retaliatory or discriminatory reasons. ( As we all wait with bated breath for a COVID-19 immunization so that life can go back to some . ( Submitting an Exemption for Reasons of Conscience. Employee Signature Date Created Date 12/8/2021 12:33:24 PM Those who fall within a covered category can request an exemption. Download, print, fill out and mail a form for each person you wish to remove. Private schools that accept state funding of any kind must also accept the exemption form. Full name of each child for whom a form is requested, Date of birth of each child for whom a form is requested, Parent or legal guardians complete return mailing address, a student who is homeless according to the federal McKinney-Vento Act. In Texas, one can also submit a COVID-19 Vaccine Exemption Form. reasons of personal conscience or religious belief. ( Secure .gov websites use HTTPS Can my employer require proof of the COVID-19 vaccine before I may return to work? If your workplace is attempting to require Covid-19 vaccines while they are still under the, , you are advised to gather documentation of their policy and contact, http://www.dshs.state.tx.us/immunize/docs/c-9.pdf, Withdrawal of Consent and Confirmation Form. In general, employers should ordinarily assume that an employees request for religious accommodation is based on a sincerely held religious held belief. How is this related to the Americans with Disabilities Act (ADA)? Licensed nursing homes that serve elderly residents offer vaccines for both pneumococcal and influenza. Texas DSHS staff continue to process conscientious exemption requests. Under the ADA, an employer may refuse to provide a reasonable accommodation to a mandatory vaccination program if it can establish undue hardship. GA-39 (8/25/21), Section 161.0085 of the Texas Health & Safety Code, Can I be required to show proof of COVID-19 vaccination or a vaccine passport?. 27 0 obj <> endobj Texas School & Child-Care Facility Immunization, Research, Funding, & Educational Resources. Finally, employers should be aware that, in certain situations, an employees adverse medical reaction to an employer-mandated vaccine may trigger a workers compensation claim. ( working from home or using personal protective equipment while at work as long as doing so would, again, not cause the employer undue hardship. Employees can bring failure to accommodate claims under Title VII by showing that they had a sincerely held religious belief conflicting with a workplace requirement, shared that belief with the employer, and was disciplined for failing to comply with the conflicting requirement. ( ", Per diem localities with county definitions shall include"all locations within, or entirely surrounded by, the corporate limits of the key city as well as the boundaries of the listed counties, including independent entities located within the boundaries of the key city and the listed counties (unless otherwise listed separately).". In 1991, the American Academy of Pediatrics recommended that all newborns be given a Hepatitis B shot within 12 hours of birth. Serologic confirmations (via a valid laboratory report that indicates confirmation of either immunity or infection) to measles, rubella, mumps, hepatitis A, hepatitis B, or varicella, are acceptable. All DFPS-licensed childcare facilities must have a policy that includes procedures for a facility employee to be exempt from the required vaccines for both medical reasons and reasons of conscience, including a religious belief. The order allows for some exceptions. ( By facsimile at (512) 776-7544. ( Texas Administrative Code (TAC) 97.62 describe the conditions under which children and students can seek exemptions from immunization requirements in Texas elementary and secondary schools, and institutions of higher education. The CDC has information on Keeping Track of Your Immunization Record. Violations of this order are punishable by fine. (Printed Name of Individual Claim ing an Exemption) from receiving the COVID -19 Vaccine based on the following reason (check one) : . This blog post from a private law firm's website discusses several updates to the EEOC's guidance on COVID-19 vaccine mandates for employees who are physically present in the workplace. Additionally, many hospitals and birthing centers, as a routine matter, administer the Hepatitis B vaccine on the basis of what is known as standing orders. Our Legal FAQ discusses state and federal laws regarding COVID-19 vaccination requirements for employees. For how long is each child's individual exemption affidavit valid? Additionally, Title VII of the Civil Rights Act could allow employees with religious beliefs against a vaccine to seek reasonable accommodations, such as working from home or using personal protective equipment while at work as long as doing so would, again, not cause the employer undue hardship. Employees can bring failure to accommodate claims under Title VII by showing that they had a sincerely held religious belief conflicting with a workplace requirement, shared that belief with the employer, and was disciplined for failing to comply with the conflicting requirement. Faith InDepth Coronavirus How employers judge religious exemption requests As they impose COVID-19 vaccine mandates, company leaders across the country are facing a flood of requests for religious exemptions By Kelsey Dallas kdallas@deseretnews.com Oct 10, 2021, 9:00pm PDT SHARE How employers judge religious exemption requests Flipboard Written request through the United States Postal Service (or other commercial carrier) to the department at: By hand-delivery at the departments physical address at 1100 West 49th Street, Austin, TX 78756. ( What will happen to the information collected on each child? Each parent or guardian who signs a vaccine exemption affidavit form also is acknowledging they understand that their child may be excluded from school attendance in times of emergency or epidemic declared by the Texas Commissioner of Health. In other words, if youre unable to get vaccinated due to a disability, and the employer concludes that you would pose a direct threat to the health or safety of yourself or others, then your employer should determine whether you may be entitled to a reasonable accommodation such as allowing you to perform your job remotely. What are my rights if my employer requires a COVID-19 vaccine, but I don't want to or am unable to receive the vaccine due to my sincerely held religious practice or belief? The vaccine exemption affidavit is part of the child's school records and should be sent to the new school with other school records. Businesses that receive state funds or who are licensed by the state are at risk of losing their contracts or licensureif they require proof of vaccination: (d) Notwithstanding any other law, each appropriate state agency shall ensure that businesses in this state comply with Subsection (c) and may require compliance with that subsection as a condition for a license, permit, or other state authorization necessary for conducting business in this state. Once notarized, the form is valid for 2 years. If you choose to receive the COVID-19 vaccine, you should receive a vaccination card, which can serve as proof of your vaccine. If faxing, mailing or hand delivering a letter to request an affidavit, your letter must include the following information: * The state allows you to request a maximum of five forms per individual per request. Not for sale. GA-40 (10/11/21), Texas Workforce Commission (TWC) Letter to Employers Regarding Executive Order GA-40, Section 418.173 of the Texas Government Code, Whos required to get vaccinated in Texas? w !1AQaq"2B #3Rbr What if my employer cannot exempt or provide a reasonable accommodation to me because of my inability to comply with a mandatory vaccine policy due to a disability or sincerely held religious practice of belief? This guidance from the Safer Federal Workforce Task Force answers questions about COVID-19 vaccine requirements for federal employees and contractors. Private hospitals and birthing facilities have a legal right to refuse to allow you to give birth in their medical facility if you do not agree to abide by their policies in advance. The most recent order Executive Order GA-40 was issued on October 11th, 2021. Four vaccination-related provisional enrollment scenarios exist. ( In 2003, the Texas legislature passed changes to the statutes expanding the reasons a parent can claim an exemption from vaccinations. This statute prohibits government entities from issuing vaccine passports to certify a person's COVID-19 vaccination status. If you choose to be exempt, you may be required to use protective equipment such as gloves or masks. ( According toguidance fromthe Safer Federal Workforce Task Force, workers must be fully vaccinated by November 22, 2021. The main purpose of the vaccination card is to allow you to keep track of which vaccine you received, the dosage you received, and the dates of each dosage. ( However,the Texas Workforce Commission issued a letter to Texas employers that states that employees can report violations of GA-40 to TWC over the phone or via e-mail. Heres what you should know (2/3/22), Texas Gov. ( Some federal protections exist that employees can explore. The completed form should be returned to the Diversity and Equal Opportunity Office at CALL@uth.tmc.edu. Are non-medical vaccine exemption forms from other states valid for enrollment in Texas childcare facilities, elementary schools, secondary schools, and institutions of higher education? Source: Texas Administrative Code Rule 1.702. Varicella can also be confirmed via a written statement from a parent/guardian, school nurse, or physician attesting to the students positive history of varicella.