The Board of Supervisors recently directed that all County employees must show proof of vaccination by October 1, 2021. In compliance with state and federal laws, we have implemented a process for employees who cannot be vaccinated to request an accommodation from the vaccination policy. This page is to provide additional information, resources, and guidance on the County’s COVID-19 Vaccine Policy Exemption/Reasonable Accommodation process.

Employees may request an accommodation from the Policy’s vaccination requirement policy due to the following reasons:

  • A medical condition or disability that does not allow an individual to get vaccinated against COVID-19; or
  • A sincerely held religious belief, practice, or observance that conflicts with an individuals ability to receive a COVID-19 vaccine.

Employees must use the process outlined below to request an accommodation.  If you have already submitted a request for an accommodation from the vaccination requirement, you will need to resubmit your request using the forms and process outlined below.

To request a medical accommodation:

You must submit the Request for Medical Accommodation Form to your Departmental HR Manager (DHRM) or their designee.  You are encouraged to submit your requests for accommodation ten (10) business days following the implementation of the Covid-19 vaccination policy.  Within ten (10) business days from submitting your request form, you must also submit a completed Healthcare Provider Certification Form from your licensed healthcare provider to support your request.

To request a religious accommodation:

You must submit the Request for Religious Accommodation Form to your Departmental HR Manager (DHRM) or their designee.  You are encouraged to submit your request for accommodation ten (10) business days following implementation of the vaccination policy.

Note:  If your department requires additional information to evaluate your request for a religious accommodation, you may be asked to submit a completed Religious Statement Form from your religious official, religious scholar, or person knowledgeable regarding your religious belief(s), practice(s) or observance(s) to support your request.

If your request for medical or religious accommodation is approved:

Your designated department personnel will send you the Approval of Accommodation Form.  In addition to documenting the department’s approval, it will also outline any additional safety protocols, if any.

You will be required to follow the safety protocols as indicated by the Public Health Department and the Centers for Disease Control and Prevention (CDC).  These may include but are not limited to:

  • Wearing a mask at all times while working at a County site or facility;
  • Participating in daily COVID-19 symptom screening;
  • Observing social distancing requirements;
  • Recurring regular COVID-19 testing.

If your request for accommodation is denied:

Your designated department personnel will send you the Denial of Exemption Form; the reason for the denial will be stated on the form.

You will have fourteen (14) calendar days from the denial date to submit proof through the Fulgent system that you have received your first dose of a two-dose COVID-19 vaccine, or a single-dose COVID-19 vaccine.  You will then have eight (8) weeks from the denial date to submit proof through the Fulgent system that you are fully vaccinated.

The denial form will include information on how you can file a request for reconsideration of your department’s decision. (see section below, titled Request for Reconsideration).

Request for Reconsideration

If your request for exemption from the Covid-19 vaccination requirement is denied, you may request a reconsideration of your request for accommodation from the Department of Human Resources (DHR).

Requests for reconsideration must be made within ten (10) business days of your Department’s denial.  You will need to provide a copy of your submitted Request for Accommodation, supporting documents, and denial form.  DHR will issue a Final Determination Notice within thirty (30) business days following receipt of the reconsideration request.

To submit a request for reconsideration, you must submit a completed Request for Reconsideration Form to, or you can mail the request to:

Los Angeles County Department of Human Resources

Attention: Reconsiderations

510 South Vermont Avenue, 12th Floor

Los Angeles, California  90020


The forms are PDF fillable and may be sent electronically or can be printed as needed.  Click the below to access forms:




For additional questions, please contact: