Explain how your sincerely held religious belief,practice,or observance specifically conflicts with the Company’s COVID-19 vaccination requirement.

COVID Religious Form.pdf

Part I: To be completed by the Individual Requesting an Exemption/Accommodation

1.Iidentify your sincerely held religious belief, practice, or observance that you believe specifically conflicts with the Company’s COVID-19 vaccination requirement:

2.Explain how your sincerely held religious belief,practice,or observance specifically conflicts with the Company’s COVID-19 vaccination requirement, and identify and describe the accommodation that you are requesting to eliminate the conflict, as well as any alternative accommodations that you believe will eliminate the conflict:

3. When did you begin following or subscribing to this religious belief, practice, or observance?

4. Would the religious belief, practice, or observance allow you to take the influenza, rubella (MMR), and/or hepatitis A vaccine, if it was required in order to work? And if so, why does the religious belief, practice, or observance allow you to take those vaccines but not the COVID-19 vaccine?

5. Identify any sources (e.g., religious texts), if any, that describe how your particular sincerely held religious belief, practice, or observance specifically conflicts with the Company’s COVID-19 vaccination requirement (or state “None,” if applicable):

NOTE: Individuals are welcome to use additional sheets to explain the basis for their request. If your request is approved, you will be exempted or receive a deferral from receiving the COVID-19 vaccine. If your request is not approved, you will be expected to receive the COVID-19 vaccine and comply with the Mandatory COVID-19 Vaccination Policy. My signature below affirms that I have read and understand the information on this form and that my request for a religious accommodation for the COVID-19 vaccination is based upon sincerely held religious beliefs, observances and practices. In addition to all other Company-related COVID-19 policies,specifically agree to all of the following requirements if my request is approved and I do not receive the COVID-19 vaccine:

(1) must wear a mask at work and maintain social distancing of 6 feet or more, except while eating or drinking when I must be more than 6 feet from any other person,

(2) may be required to use an N95 mask instead of surgical mask and/or receive periodic COVID-19 infection control trainings, as a method of source control (does not apply to those performing remote work at home)