The County will continue to use the existing process to support vaccination exemption requests for those employees that must remain in compliance with federal, state, and local COVID-19 vaccination laws and are unable to be vaccinated.

This page provides additional information, resources, and guidance on the request for the COVID-19 Vaccination Exemption/Reasonable Accommodation process.

Employees who are subject to the vaccination requirement may request an accommodation 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 individual’s ability to receive a COVID-19 vaccine.


To request a medical accommodation:

You must submit the Request for Medical Accommodation Form to your Departmental HR Manager (DHRM) or their designee.  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.

Note:  If additional information is required to evaluate your request for a religious accommodation, you may be asked to submit a completed Religious Request for Clarification Form 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 adhere to all workplace screening requirements and safety protocols applicable to the County facility or work location requirements and/or when in contact with members of the public while working.

If your request for accommodation is denied:

Your designated department personnel will send you the Denial of Request for 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. Note, a booster may also be required and must be obtained within the specified guidelines.

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.  Your department will issue a Final Determination Notice 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: