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EMPLOYEE VACCINATION STATUS VERIFICATION FORM » EMPLOYEE VACCINATION STATUS VERIFICATION FORM

EMPLOYEE VACCINATION STATUS VERIFICATION FORM

 
 
The Southern Humboldt Unified School District (IUSD) is committed to protecting the health and safety of our students and staff members. Consistent with the California Department of Public Health Order dated August 11, 2021, Government Newsom’s announcement of the same date, and in order with Cal/OSHA regulations and guidance, we are required to determine our employees’ vaccination status in order to address safety conditions that may arise due to the presence of COVID-19 in the workplace. An employee is deemed “fully vaccinated” when an employer has documented that the person received, at least 14 days prior, either the second dose in a two-dose COVID-19 vaccine series (Pfizer/Moderna) or a single-dose COVID-19 vaccine (Johnson & Johnson). In compliance with current guidance, SHUSD will require all employees to either submit proof of full vaccination or be tested at least once per week.
 
Employees that are asymptomatic unvaccinated or incompletely vaccinated will be required to undergo diagnostic screening testing at least once per week. Unvaccinated or incompletely vaccinated workers must also observe all other infection control requirements, and are not exempted from the testing requirement even if they have a medical contraindication to vaccination, since they are still potentially able to spread the illness.  Note: A previous history of COVID-19 from which the individual recovered more than 90 days earlier, or a previous positive antibody test for COVID-19, do not waive this requirement for testing.
 
Fully vaccinated employees may participate on a voluntary basis or be required to participate in the testing program if they are experiencing symptoms of COVID-19, or have had confirmed close contact to a positive case. Testing requirements are subject to change based upon community transmission data. A similar requirement is also being considered for students.
 
The District is hoping to continue to host COVID-19 vaccine clinics to serve the needs of all of our stakeholders. We are planning to offer a clinic at each school site and we encourage you and your families to take advantage of these opportunities. A COVID-19 Vaccine Clinic Schedule will hopefully be forthcoming.
 
In accordance with Cal/OSHA regulations, SHUSD is required to document employee vaccination status in order to ease some COVID-19 related protocols and procedures for fully vaccinated employees, when it is safe to do so in the future. Employees who respond that they are vaccinated must do one of the following:
 
1) Upload proof of vaccination (vaccine card, image of vaccine card or health care document showing vaccination status) and the District maintains a copy; or
 
2) Proof of vaccination shown to the Human Resources Division, and the District maintains a record of the employees who presented proof, but not the vaccine record itself
 
Your response to this survey and your vaccination status will be treated as confidential and protected from unauthorized use or access. Please note that regardless of your responses to the screening surveys, you must report your vaccination status to the Human Resources Division in this survey.  It is important that you are honest in your responses.  Inaccurate or dishonest entries in response to this survey are subject to disciplinary action.
 
In an effort to alleviate employee concerns relating to HIPAA, confidentiality, and employer documentation of employee vaccination status, please note that we have reviewed this concern and determined that HIPAA does not apply to health information maintained by SHUSD in this instance. Additionally, employer documentation of employee vaccination status is expressly required under California Division of Occupational Safety and Health (Cal/OSHA) Emergency Temporary Standards, and is not prohibited by the Americans with Disabilities Act (ADA), California’s Fair Employment and Housing Act (FEHA), or related laws.
 
COVID-19 vaccines that are currently authorized for emergency use:
 
• By the US Food and Drug Administration (FDA), are listed at the FDA COVID-19 Vaccines webpage
 
• By the World Health Organization (WHO), are listed at WHO COVID-19 Vaccines webpage
 
• “Incompletely vaccinated” means persons who have received at least one dose of COVID-19 vaccine but do not meet the definition of fully vaccinated.
 
 

SHUSD COVID-19 Vaccine Status Verification

 
“Incompletely vaccinated” means persons who have received at least one dose of COVID-19 vaccine but do not meet the definition of fully vaccinated. “Unvaccinated” means persons who have not received any doses of COVID-19 vaccine or whose status is unknown.
 
If you decline to provide information about your vaccination status, are not fully vaccinated, or if your status is unknown, we are required to assume you are unvaccinated for purposes of rules or requirements in the workplace. These include:
 
• Asymptomatic unvaccinated or incompletely vaccinated workers are required to undergo diagnostic screening testing. Such workers may be tested with either antigen or molecular tests to satisfy this requirement, but unvaccinated or incompletely vaccinated workers must be tested at least once weekly with either PCR testing or antigen testing. Any PCR (molecular) or antigen test used must either have Emergency Use Authorization by the U.S. Food and Drug Administration or be operating per the Laboratory Developed Test requirements by the U.S. Centers for Medicare and Medicaid Services.
 
• Unvaccinated or incompletely vaccinated workers must also observe all other infection control requirements, and are not exempted from the testing requirement even if they have a medical contraindication to vaccination, since they are still potentially able to spread the illness. A previous history of COVID-19 from which the individual recovered more than 90 days earlier, or a previous positive antibody test for COVID-19, do not waive this requirement for testing.