EEOC shares its own religious accommodation form as sample for vaccine requirement exemption requests

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By Pamela Wolf, J.D.

On October 28, 2021, the EEOC again updated its question-and-answer technical assistance on COVID-19, the ADA, the Rehabilitation Act, and other equal employment opportunity laws, this time to provide a sample form for employees to use when requesting a religious accommodation to an employer vaccine requirement.

Requesting religious accommodation. Earlier this week, on October 25, the EEOC added a new section (L) on Title VII and religious objections to COVID-19 vaccination mandates (see Updated COVID-19 Q&As discuss religious accommodations to vaccination mandates, October 26, 2021). In that section the Commission explained, among other things, that employees are required to tell their employer if they are requesting an exception to a COVID-19 vaccination mandate because of a conflict between that requirement and their sincerely held religious beliefs, practices, or observances (religious beliefs). In making such a request, employees are not required to use any “magic words,” such as “religious accommodation” or “Title VII.” However, they do need to notify the employer that there is a conflict between their sincerely held religious beliefs and the employer’s COVID-19 vaccination requirement.

The same principles apply when employees have a religious conflict with getting a particular vaccine and would like to wait until an alternative version or specific brand of COVID-19 vaccine is available.

The EEOC also suggested the best practice is that employers provide employees and applicants with information about whom to contact, and the procedures (if any) to use, to request a religious accommodation.

Sample form. The Commission has now added, as an example, its own workplace religious accommodation request form. The EEOC explained that, although its internal forms typically are not made public, the agency has shared it in this latest technical assistant update due to “the extraordinary circumstances facing employers and employees due to the COVID-19 pandemic.”

The form, among other things, asks the requester to answer four inquiries:


Please identify the EEOC requirement, policy, or practice that conflicts with your sincerely held religious observance, practice, or belief (hereinafter “religious beliefs”).


Please describe the nature of your sincerely held religious beliefs or religious practice or observance that conflict with the EEOC requirement, policy, or practice identified above.


What is the accommodation or modification that you are requesting?


List any alternative accommodations that also would eliminate the conflict between the EEOC requirement, policy, or practice and your sincerely held religious beliefs.

Additionally, the form provides sections to explain the decision made in response to the request, as well as information about requesting reconsideration and pursuing administrative and collective bargaining rights, or those enforced by the Merit Systems Protection Board.

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