Vaccines are a critical tool in protecting you and your community from severe COVID-19 illness, hospitalization and death. They are proven safe and are now protecting millions of vaccinated New Yorkers from COVID-19.
Must have NYS DOH 4482 form filled out by a physician, physician assistant, nursepractitioner, nurse-midwife or licensed midwife. It can be found online
NOTE: Title VII and the ADA requires an employer to provide reasonable accommodations for employees who, because of a disability or a sincerely held religious belief, practice, or observance, do not get vaccinated for COVID-19, unless providing an accommodation would pose an undue hardship on the operation of the employer's business.
DECLINE THE COVID-19 VACCINE AT THIS TIME, DUE TO A
SINCERELY HELD RELIGIOUS BELIEF. AS A HEALTHCARE WORKER I AM MANDATED TO BE FULLY
VACCINATED, AND I UNDERSTAND THAT THE AGENCY MAY REQUIRE ADDITIONAL INFECTION CONTROL MEASURES, INCLUDING BUT NOT LIMITED TO WEEKLY TESTING.