Employer Vaccination Mandate Exemption Portal
Case Id
Required:
Any supporting documentation you would like the administrative law judge to consider.
Acceptable file types are:
.jpg .png .pdf.
Max size:
4 MB
By selecting this box, I hereby swear or affirm that the information in this request is true and accurate. I understand that providing false or misleading information is grounds for prosecution for perjury.
Note:
Please allow up to 30 days for a decision to be made.
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Poster
Exemption Form
Employer’s Response to Request for Administrative Review:
Please upload copies of any documentation or evidence you would like for the administrative law judge to consider in their review of your employee’s denied vaccination exemption claim.