J-10. DOD Guidance for COVID-19 Vaccination_2021-12-20.PDF

UNDER SECRETARY OF DEFENSE

4OOO DEFENSE PENTAGON

WASHtNGTON, D.C. 20301 -4000 ßäc 2 r 2021

PERSONNEL AND

READINESS

MEMORANDUM FOR SENIOR PENTAGON LEADERSHIP

COMMANDERS OF THE COMBATANT COMMANDS

DEFENSE AGENCY AND DOD FIELD ACTIVITY DIRECTORS

SUBJECT: Force Health Protection Guidance (Supplement23) Revision 3 - Department of Defense Guidance for Coronavirus Disease2}lg Vaccination Attestation, Screening Testing, and Vaccination Verifi cation

This memorandum rescinds and replaces reference (a),1 and provides updated guidance for implementing additional force health protection and worþlace safety measures directed by the White House Safer Federal V/orkforce Task Force (reference (b)) to reduce the transmission of the virus that causes coronavirus disease 2019 (COVID-I9).

In accordance with references (b), (c), and (d), DoD civilian employees were required to be fully vaccinated by November 22,2021, subject to exemptions as required by law. For purposes of this guidance, "DoD civilian employee" includes foreign nationals employed by DoD outside the United States to the maximum extent possible while respecting host nation agreements and laws. It also includes DoD civilian employees who are engaged in full-time telework or remote work. Additional information about the requirements for DoD civilian employees can be found in Attachment 1.

DoD contractor personnel and official visitors must attest to being fully vaccinated and, if not fully vaccinated, present the results of a recent negative COVID-I9 test as a condition of physical access to DoD buildings and DoD-leased spaces in non-DoD buildings in which official DoD business takes place (referred to jointly in this memorandum as "DoD facilities"). For purposes of this physical access requirement, "contractor personnel" ate those individuals issued a credential by DoD that affords the individual recurring access to DoD facilities, classified herein as "credentialed recurring access" (CRA) (e.g., Common Access Cardholders). "Official visitors" are non-DoD individuals seeking access, one time or recurring, in association with the performance of offrcial DoD business (e.g., to attend a meeting), but who do not have CRA. The COVID-I9 vaccination status for all individuals with CRA and official visitors will be determined in accordance with Attachment 2.

These vaccination and physical access requirements do not apply to personnel receiving ad hoc access to DoD facilities (e.g., delivery personnel, taxi services); to individuals who have access to the grounds of but not the buildings on, DoD installations (e.g., contract groundskeepers, fuel delivery personnel, household goods transportation personnel); to personnel accessing DoD buildings unrelated to the performance of DoD business (e.g., residential housing); or to personnel accessing DoD facilities to receive a public benefit (e.g., commissary;

I References are listed in Attachment 10.

exchange; public museum; air show; militarymedical treatment facility; Morale, Welfare, and Recreation resources).

In accordance with reference (e), Service members (members of the Armed Forces under DoD authority on active duty or in the Ready Reserve, including members of the National Guard) are required to be fully vaccinated against COVID-19. Service members' vaccination status will be validated utilizing their Military Service-specific Individual Medical Readiness (IMR) system. If a Service member has been vaccinated against COVID-I9 outside the Military Health System, that Service member must show official proof of his or her COVID-l9 vaccination status to update the IMR system. Once the applicable mandatory vaccination date has passed, COVID-19 screening testing as described in Attachment 7 is required at least weekly for Service members entering a DoD facility who are not fully vaccinated, including those who have an exemption request under review, or who are exempted from COVID-I9 vaccination.

Service members who are not on active duty and who also are DoD civilian employees or DoD contractor personnel must follow the applicable requirements in this memorandum for DoD civilian employees or DoD contractor personnel, as the case may be. Service members not on active duty must comply with any other applicable DoD or DoD Component guidance. Service members who are actively participating in COVID-19 vaccine clinical trials begun prior to November 22,2021are exempted from mandatory vaccination against COVID-19 until the trial is complete in order to avoid invalidating such clinical trial results.

Individuals are considered fully vaccinated 2 weeks after completing the second dose of a two-dose COVID-I9 vaccine or 2 weeks after receiving a single dose of a one-dose COVID-l9 vaccine. Individuals must be vaccinated with vaccines that are either fully licensed or authorized for emergency use by the Food and Drug Administration (FDA) (e.g., Pfizer- BioNTeoh/COMIRNATY, Moderna, Johnson & Johnson/Janssen vaccines); listed for emergency use on the World Health Organization Emergency Use Listing (e.g., AstaZeneca/Oxford); or approved for use in a clinical vaccine trial for which vaccine efficacy has been independently confirmed (e.g., Novavax). Those with previous COVID-I9 infection(s) or antibody test results are not considered fully vaccinated on that basis for the purposes of this memorandum.

All medical and other information collected from individuals will be maintained in a manner meeting the privacy requirements in Attachment 9.

The Secretaries of Military Departments and the Director of Administration and Management for all other DoD Components will publish any necessary supplemental instructions and ensure that all contract and associated funding implications are considered.

DoD Components should engage with DoD civilian employee unions as they develop supplemental guidance and otherwise satisfy any applicable collective bargaining obligations under the law at the earliest convenience, including on a post-implementation basis.

This memorandum and other COVID-I9 guidance memoranda are centrally located at:

https://www.defense.gov/Spotlights/Coronavirus-DOD-Response/Latest-DOD-Guidance/.

Please direct any questions or comments to the following email address: dha.ncr.ha-support. list.policy-hrpo-kmc-owners@mail.mil.

Gilbert R. Cisneros, Jr

Attachments:

1. ATTACHMENT 1: Vaccination Requirements for DoD Civilian Employees

2. ATTACHMENT 2: Requirements for DoD Contractor Personnel, Official Visitors, and

Others Seeking Access to Facilities

3. ATTACHMENT 3: DD Form 3175 - "DoD Civilian Employee Certification of

Vaccination"

4. ATTACHMENT 4: DD Form 3150 - "Contractor and Visitor Certification of Vaccination"

5. ATTACHMENT 5: DD Form 3176 - "Request for a Medical Exemption or Delay to the

COVID- 1 9 Vaccination Requirement"

6. ATTACHMENT 6: DD Form 3Il7 - "Request for a Religious Exemption to the COVID-I9

Vaccination Requirement"

7. ATTACHMENT 7: COVID-l9 Screening Testing Requirements

8. ATTACHMENT 8: Requirements for Obtaining Self-Collection Kits and Self-Tests

9. ATTACHMENT 9: Privacy Requirements

10. ATTACHMENT 10: References

ATTACHMENT 1

Vaccination Requirements for DoD Civilian Employees

1. Vaccination Requirement

a. DoD civilian employees are required to be fully vaccinated, unless they have received a temporary or permanent exemption. DoD civilian employees who are actively participating in COVID-l9 vaccine clinical trials begun prior to November 22,2027, are exempted from mandatory vaccination against COVID-19 until the trial is complete in order to avoid invalidating such clinical trial results.

b. DoD civilian employees who are not fully vaccinated must comply with all DoD requirements for individuals who are not fully vaccinated, including those requirements related to masking, physical distancing, and travel. Weekly COVID-I9 testing is required for those DoD civilian employees who are not fully vaccinated, including those who have medical or religious exemptions. DoD civilian employees who telework or work remotely on a full-time basis are not subject to weekly testing, but must provide a negative result from a test performed within the prior 72 hours for entry into a DoD facility.

c. DoD civilian employees are eligible to receive the COVID-l9 vaccine at any DoD vaccination site, including military medical treatment facilities. They may also opt to receive the COVID-19 vaccine at locations other than DoD vaccination sites, such as retail stores, private medical practices, and/or local and State public health department sites.

d. New DoD civilian employees must be fully vaccinated by their entry on duty (start) date.

l. The DoD or Office of the Secretary of Defense (OSD) Component head concerned may approve temporary exemptions in writing for up to 60 days after a DoD civilian employee's start date for urgent, mission-critical hiring needs in circumstances in which a DoD civilian employee could not have been fully vaccinated between the time the job opportunity announcement closes and the DoD civilian employee's start date. This authority may be delegated in writing to the DoD or OSD Component head's Principal Deputy (or equivalent) but no lower.

DoD Components must address the COVID-19 vaccination requirement in job opportunity announcements and tentative and final offer letters. For hiring actions currently underway, DoD Components must issue revised tentative and final offer letters. Sample language can be found in reference (f).

e. DoD civilian employees are authorized official duty time to receive vaccination doses. For DoD civilian employees who are unable to receive a COVID-19 vaccination within their duty hours, regular overtime rules are applicable.

f. DoD civilian employees are authorized administrative leave for purposes of taking a family member to get a vaccination and for themselves to recover from vaccination.

DoD civilian employees who experienco an adverse reaction to a COVID-19 vaccination should be granted no more than two workdays of administrative leave for recovery associated with a single COVID-19 vaccination dose. DoD civilian employees should use the time and attendance code for "physical frtness" to record administrative leave for COVID-19 vaccination recovery time that prevents the employee from working or for taking a family member to be vaccinated for COVID-

19. The type hour code is erLN)' and the environmentallhazardlother code is "PF".

Non-appropriated fund employers should code administrative leave related to COVID-19 in a way that can be easily reported.

2. Verification of Vaccination

a. DoD civilian employees who have received a dose of a one-dose vaccine, or both doses of a two-dose vaccine, must provide proof of vaccination to their direct supervisor. For purposes of the vaccination data submission and verification requirements, "direct supervisor" includes an authorized human resources official.

b. Proof of vaccination may be submitted either in hard copy or in an electronic format.

The proof may be a photocopy or photograph of the vaccination record, if it legibly displays the data points to be verifìed by the supervisor. DoD civilian employees who are not fully vaccinated must provide proof of vaccination to their supervisor upon receipt of each required dose. Acceptable proof includes:

i. A copy of the record of immunization from a health care provider or pharmacy;

ii. A copy of the COVID-19 Vaccination Record Card (CDC Form MLS- 319813_r, published on September 3,2020);

iii. A copy of medical records documenting the vaccination;

iv. A copy of immunization records from a public health or State immunization information system; or

v. A copy of any other official documentation containing the data points required to be verified by the supervisor.

c. In addition to providing proof of vaccination to their supervisors, DoD civilian employees also will complete Section A of DD Form 3175 (Attachment 3). DoD civilian employees with access to milConnect (https://milconnect.dmdc.osd.miU) will complete the DD Form 3175 viamilConnect; otherwise use of a hard copf is acceptable. DoD civilian employees who complete the DD Form 3175 via milConnect do not need to email or otherwise transmit a copy of the form to their supervisors. DoD civilian employees using a hard copy will provide the hard copy to their supervisor. DoD civilian employees are required to complete the DD Form 3175 even if they already completed the DD Form 3150 (Attachment 4).

2 https://www.esd.whs.miVPortals/S4/Documents/DD/forms/dd/dd3 1 75.pdf

d. Upon receiving proof of vaccination, a DoD civilian employee's supervisor will verify that the proof of vaccination provided contains the following data points:

l.

ii.

Type of vaccine administered;

Number of doses received;

Date(s) of administration; and Name of the health care professional(s) or clinic site(s) administering the vaccine(s).

111.

iv.

e. In addition to verifying that a DoD civilian employee's proof of vaccination includes the requireddatapoints, supervisors also will complete Section B of DD Form 3175.

Supervisors with access to milConnect (https://milconnect.dmdc.osd.miV) will complete the DD Form 3775 viamilConnect using the DoD civilian employee's Employee Identification Number; otherwise use of a hard copy is acceptable.

f. Supervisors will retain DoD civilian employees' proof of vaccination and DD Form 3175 (for those DoD civilian employees not using milConnect) in accordance with their DoD Component's recordkeeping requirements for DoD civilian employee medical records and the privacy requirements contained in Attachment 9.

Supervisors should not ask for copies of the DD Form 3175 from those employees who used milConnect to complete the form. Supervisors who receive completed copies of the DD Form 3175 from DoD civilian employees who completed the DD Form 3175 using milConnect shall destroy the copy or return it to the employee.

g. DoD civilian employees may not be required to use their own personal equipment for the purpose of submitting proof of vaccination or DD Form 3175. DoD civilian employees who submit proof of vaccination or the DD Form 3175 in an electronic format are encouraged to use encrypted email or password protected files with DoD S AFE file transfer (https : //safe. apps. mil/).

3. Enforcement of DoD Civilian Employee COVID-l9 Vaccination Requirement:

a. DoD civilian employees who refuse to be vaccinated, or to provide proof of vaccination, are subject to disciplinary measures, up to and including removal from Federal service, unless the DoD civilian employee has received an exemption or the DoD civilian employee's request for an exemption is pending a decision. DoD Components should generally follow the recommended guidelines in reference (g), subject to any applicable Component policy and collective bargaining agreements.

b. Progressive enforcement actions include, but are not limited, to

i. A 5 calendn-day period of counseling and education;

ii. A short suspension without pay, generally 14 calendar days or less, with an appropriate notice period. Senior Executive Service members may only be suspended for more than 14 calendar days;

iii. Removal from Federal service for failing to follow a direct order.

c. During the notice periods preceding adverse employment actions, DoD civilian employees generally should not be placed on administrative leave. DoD Components should require DoD civilian employees to continue to telework or report to the worksite and follow all mitigation measures applicable to not fully vaccinated DoD civilian employees when reporting to the worksite.

d. DoD Components will designate officials, at the appropriate organizational level, to handle the disciplinary process to promote consistent application of disciplinary measures. Such officials will decide each case with due regard to the facts and circumstances of that case.

e. Supervisors should contact their servicing human resources and legal offices to discuss options available to address individual situations regarding enforcement of this requirement.

f. For employees who have not yet attested to vaccination status; are not vaccinated and did not submit an exemption request, or have not begun vaccination following denial of an exemption request, Components are generally encouraged to continue with robust education and counseling efforts as the first step in an enforcement process, with no subsequent enforcement actions beyond that education and counseling and, if warranted, a letter of reprimand, until the new calendar year begins in January 2022.

g. DoD Components are encouraged to identify an occupational health office, medical office, or other resource with which a DoD civilian employee may consult during the period of counseling and education.

4. Exemptions to DoD Civilian Employee COVID-l9 Vaccination Requirement:

a. Exemption Requests and Decision-Making Procedures. DoD civilian employees may request an exemption on the basis of a medical condition or circumstance or a sincerely held religious belief, practice or observance. Because all DoD civilian employees must now be vaccinated against COVID-19 as a condition of employment, exemptions will be granted in limited circumstances and only where legally required.

The Secretaries of the Military Departments and the Director of Administration and Management for all other DoD Components will oversee Component implementation of the following decision-making procedures.

b. Personnel

Decision Authorities. Management official(s) will be designated to serve as Decision Authorities to make decisions conceming requests for exemption from the COVID-19 vaccination requirement, in consultation with the organization's servicing legal office. Decision Authorities will be at an appropriate level within the organization to consider the impact, if any, that granting a request will have on the DoD Component operations and to promote similar cases being handled in a consistent manner, with due regard ll

111.

for the facts and circumstances of each case. Each employee's request must be considered on its own merits.

Subject Matter Experts. DoD Components may identify subject matter experts in areas such as human resources (HR), equal employment opportunity (EEO), medicine, and religious matters to serve as advisors to assist Decision Authorities. Such advisors may provide individual advice, as needed by the Decision Authority, but may not be used to develop a group or consensus recommendation or decision.

Administrative Support. DoD Components will provide appropriate personnel and other resources to administratively support the Decision Authorities, including support necessary to assist the Decision Authorities with preparing written products.

c. Employee Notice. DoD Components will inform DoD civilian employees how to make a request for an exemption and notify them that requests must have been submitted no later than November 8,202I, absent extenuating circumstances, to be considered timely. A DoD civilian employee's failure to submit a timely request for exemption is not a basis to deny a request but may be relevant in evaluating the request.

d. Employee Responsibilities. To make a request for exemption from the COVID-I9 vaccination requirement, DoD civilian employees must submit a request to their direct supervisor. For purposes of submitting this exemption request, "direct supervisor" includes an authorized human resources official. The employee must provide an official statement which describes the medical or religious reason the employee objects to vaccination against COVID-I9. Generally, such requests must be in writing. DoD civilian employees may use DD Form 3176 (Attachment 5) or DD Form 3177 (Attachment 6) to submit their requests. DoD civilian employees who make oral requests may be provided a sample written request format and/or be interviewed to develop the basis for the request. While the use of the DD Form 3 176 and DD Form 3177 is optional for DoD civilian employees, when DoD civilian employees make a request, they must provide the following information:

Medical Exemption Requests.

o A description of the medical condition or circumstance that is the basis for the request for a medical exemption from the COVID-19 vaccination requirement;

o An explanation of why the medical condition or circumstance prevents the employee from being safely vaccinated against COVID-l9;

o If it is a temporary medical condition or circumstancq a statement concerning when it will no longer be a medical necessity to delay vaccination against COVID-l9; and

. Any additional information, to include medical documentation that addresses the employee's particular medical condition or circumstance, which may be helpful in resolving the employee's request for a medical exemption from the COVID-I9 vaccination requirement.

l.

l1 Religious Exemption Requests.

o A description of the religious belief, practice, or observance that is the basis for the request for a religious exemption from the COVID-I9 vaccination requirement;

o A description of when and how the DoD civilian employee came to hold the religious belief or observe the religious practice;

o A description of how the DoD civilian employee has demonstrated the religious belief or observed the religious practice in the past;

o An explanation of how the COVID-19 vaccine conflicts with the religious belief, practice, or observance;

o A statement concerning whether the DoD civilian employee has previously raised an objection to a vaccination, medical treatment, or medicine based on a religious belief or practice. If so, a description of the circumstances, timing, and resolution of the matter; and

. Any additional information that may be helpful in resolving the DoD civilian employee's request for a religious exemption from the COVID-19 vaccination requirement.

e. Supervisor Responsibilities.

i. Following receipt of an employee's request for exemption, supervisors must update Section B of the employee's DD Form 3175 to indicate that a request for exemption determination is pending.

ii. As necessary, supervisors will engage with the employee to ensure completeness of the employee's exemption request.

iii. In coordination with human resources officials, supervisors will prepare an exemption request package that contains factual information about the circumstances of the employee's request. A complete exemption request package will include the basis for the employee's request and any supporting documentation submitted by the employee, a description of the nature of the employee's job responsibilities and work environment, and any circumstances relevant to a management-level assessment of the reasonably foreseeable effects on the agency's operations, including protecting the agency's workforce and members of the public with whom the employee interacts in the worþlace from COVID-I9, if the employee remains unvaccinated.

iv. Supervisors will forward the exemption request package to the Decision Authority Support Offi ce.

f. Decision Authority Support Office.

DoD Components will establish Decision Authority Support Offices to support exemption request Decision Authorities.

The Decision Authority Support Office will intake exemption request packages and, under the supervision of the Decision Authority, provide administrative support to the Decision Authority.

At the request of the Decision Authority, the Decision Authority Support l.

ii.

1V

Office may coordinate with subject matter experts to obtain written documentation which includes relevant factual information and, as necessary, a professional opinion related to the factual information, for inclusion in the exemption request package.

The Decision Authority Support Office may not provide a consensus opinion or recommendation to the Decision Authority.

g. Decision Authority Determination.

i. The Decision Authority f,rrst analyzes the exemption request package. As necessary, the Decision Authority may request additional information and consult with subject matter experts.

ii. After conducting a review of the exemption request, the Decision Authority makes a determination, prepares a written statement that includes the reasons for the determination (which may involve drafting assistance based on the Decision Authority's instructions regarding its contents), and obtains a legal review of the determination.

iii. In cases where the exemption is temporary or denied, the Decision Authority's determination must specifu a date by which the DoD civilian employee must be fully vaccinated against COVID-19. In specifying that date, DoD civilian employees must be given a minimum period of 14 days to receive their first (or only) dose of a COVID-I9 vaccine.

h. Employee Notification of Determination. The Decision Authority Support Office will transmit the Decision Authority's written determination to the DoD civilian employee's supervisor, who, in turn, provides the DoD civilian employee with a copy of the written determination, updates the DD Form 3775, and informs the DoD civilian employee of next steps.

i. A chart illustrating the exemption request process is below

Position Role/Responsibilitv Output Submit to Requesting employee Attest to vaccination status via DD Form 3175 to indicate exemption pending.

Completed DD Form 3175.

Supervisor

Requesting employee Request exemption. Completed DD Form 3176 (medical) or DD Form 3177 (religious), as appropriate, or other request that contains the information required by FHP 23, Revision 3.

Supervisor

Supervisor, in consultation with HR officials

Provide relevant information concerning employee's occupation and work environment, to include: availability of measures to physically distance requestor from co-workers and members of the public, the volume of exemption requests in the organization, and any other relevant information concerning the circumstances of the employee's request.

Exemption request package that includes employee's request and supervisory information concerning employee's occupation, work environment, and other circumstances of the request.

Decision Authority Support Office

Decision Authority Support Office

Receive and track processing of exemption request package. Supplement package with individual advice from subject matter experts and relevant factual information, as directed by the Decision Authority.

Exemption request package that includes employee's request;

supervisor information concerning employee's occupation, work environment, and other circumstances ofthe request; and any supporting documentation relevant to the Decision Authority's analysis.

Decision Authority

Decision Authority Review submitted documentation, request any reasonably necessary additional information, and prepare written decision in consultation with legal advisors and with the advice of subject matter experts as appropriate.

Written decision that addresses employee's individual circumstances and has been reviewed by appropriate legal advisors.

Supervisor

Supervisor Receive decision, discuss with employee. If exemption approved, implement mitigation measures and, if necessary, address any follow-on requests for accommodation in accordance with Component EEO procedures. If disapproved, provide opportunity for counseling by medical professional or other appropriate experl initiate requirement for vaccination. Work with the legal advisor(s) and, as appropriate, HR LMER and EEO offices.

Ifapproved, employee continues to comply with generally-applicable mitigation measures (e.g., screening testing, masking, and physical distancing) and any other mitigation measures directed by the Decision Authority or management officials. If disapproved, vaccination tracking and/or progressive discipline.

Employee

j. Exemption Criteria.

Religious Exemption Requests. Requests for religious exemption will be analyzed pursuant to the Religious Freedom Restoration Act of 1993 (RFRA), 42 U.S.C. $ 2000bb et seq. RFRA prohibits the Government from substantially burdening a person's exercise of religion, unless it demonstrates ll that application of the burden to the person is in furtherance of a compelling govelnmental interest and is the least restrictive means of furthering that compelling govefirmental interest. ln the first instance, Decision Authorities are to determine whether the requestor has met his or her burden to establish that the vaccination requirement imposes a substantial burden on exercise of a sincerely held religious belief. If so, Decision Authorities analyze the request to determine whether the burden on religious exercise is the least restrictive means of furthering the Government's compelling interest in health and safety of the DoD workforce, and the health and safety of members of the public with whom they interact. If vaccination is not the least restrictive means, the exemption will be granted and supervisors will implement the less restrictive means.

Medical Exemption Requests. Pursuant to the Rehabilitation Act of 1973, as amended, 29 U.S.C. $ 791 et seq. Decision Authorities will analyze requests for medical exemption to determine whether the medical condition or circumstance prevents the employee from safely being vaccinated. If so, the employee will be exempt from vaccination (temporarily or perrnanently, as appropriate). Supervisors will direct compliance with applicable force health protection guidance and direct any mitigation measures that are necessary to prevent the spread of the virus that causes COVID-19 in the worþlace and to the members of the public with whom the employee interacts. If such measures result in the employee being unable to perform the essential functions of the position, such matters will be referred to the equal emplo¡rment opportunity reasonable accommodation process.

k. AdditionalGuidance.

lll.

Information collected concerning medical and religious exemption requests must be maintained in accordance with the privacy requirements in Attachment 9. Requests for medical exemption will be treated as medical records to be maintained separately from other personnel files.

Discipline for failure to meet the COVID-19 vaccination requirement will not be initiated against a DoD civilian employee while a request for a medical or religious exemption from the COVID-19 vaccination requirement is pending determination. If a DoD civilian employee submits a request after discipline is initiated, disciplinary measures may be held in abeyance where appropriate.

DoD civilian employees who are not fully vaccinated but who have a pending request for exemption from vaccination are required to comply with all force health protection and mitigation measures that are applicable to DoD civilian employees in the worksite who are not fully vaccinated (for example, screening testing (Attachment 7), masking, and physical distancing).

Requests for reasonable accommodation related to those measures will be combined with any pending medical or religious exemption to vaccination request, for purposes of making a f,rnal determination conceming those measures. Without making a finding conceming whether a sufficient basis for a reasonable accommodation concerning those measures exists, the supervisor ll.

may use the normal interactive process to pursue a temporary accommodation that protects the health and safety of the workplace while a decision conceming those measures is pending. Otherwise, requests for reasonable accommodation related to force health protection and mitigation measures may be analyzed separately from requests for exemption from vaccination.

iv. A DoD civilian employee who receives an exemption from the vaccination requirementmay, because of the exemption, be unable to perform the duties and responsibilities of the position without a change in working conditions.

Supervisors will immediately implement any mitigation measures required by the Decision Authority and applicable force health protection guidance.

Supervisors may engage in the normal interactive process concerning any other measures necessary to protect the health and safety of the worþlace.

v. Requests for exemption from candidates for employment will be handled consistent with the provisions in this attachment.

vi. Unless responsibility is otherwise established in a written support agreement, the Combatant Command Support Agent identified in reference (h) is responsible for administration of exemption processes applicable to DoD civilian employees assigned, detailed, or otherwise deployed to a Combatant Command area of responsibility.

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ATTACHMENT 2

Requirements for DoD Contractor Personnel, Offïcial Visitors, and Others Seeking Access to Facilities

1. DoD Contractor Personnel

a. For DoD contractor personnel, the DoD civilian vaccination deadline of November 22,2021, does not apply. Vaccination requirements for DoD contractor personnel will be in accordance with reference (i), as implernented by reference 0), as directed under Executive Order 14042 (reference (k)).

b. DoD contractor personnel will complete the DD Form 3150, "Contractor and Visitor Certification of Vaccination" (Attachment4),maintain a current completed DD Form 3150, and show it to authorized DoD personnel upon request. Failure to complete the DD Form 3150 may result in denying DoD contractor personnel access to the DoD facility to which access is sought.

c. DoD contractor personnel who are not fully vaccinated against COVID-l9 because they are not performing under a covered contract that requires COVID-19 vaccination, due to a legally required accommodation, or who decline to attest to their COVID-19 vaccination status will be subject to COVID-19 screening testing at least weekly as set forth in this guidance (AttachmentT). DoD contractor personnel who refuse required screening testing will be denied access to DoD facilities.

d. In accordance with applicable contracts, DoD contractor personnel may be offered, but are not required to receive, COVID-I9 vaccines at their DoD worksites.

2. Official Visitors

a. Official visitors will complete DD Form 3150, "Contractor and Visitor Certification of Vaccination"3 (Attachment 4); andmaintain a current completed DD Form 3150 and show it to authorized DoD personnel, upon request. Failure to complete the DD Form 3150 may result in denial of an official visitor's access to the DoD facility to which access is sought.

b. Official visitors who are not fully vaccinated against COVID-19, or who decline to volunteer their COVID-19 vaccination status, must show an electronic or paper copy of negative results from an FDA-authonzed or approved COVID-I9 test administered no earlier than72 hours prior to their visit. If an official visitor is unable to show a negative COVID-19 test result, the visitor may be provided onsite self-testing, if available, or will be denied access to the DoD facilities to which access is sought.

Service members who are not on active duty at the time of their official visit are subject to the requirements in this paragraph.

3 https://www.esd.whs.miUPortals/S4/Documents/DD/forms/dd/dd3 150.pdf

c. Offieial visitors will follow applicable policies and procedures of both DoD and the Department or Agency they are visiting, if different from DoD.

3. Others Seekins Access to Facilities

Individuals other than official visitors seeking access to facilities located on DoD installations, but operated by other Federal dçartments and agencies, will follow the policies and procedures of that other department or agency.

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ATTACHMENT 3

DD Form 3175 - "DoD Civilian Employee Certification of Vaccination"

CUI (when filled in)

DoD CIVILIAN EMPLOYEE CERTIFICATION OF VACCINATION

PRIVACY ACT STATEMENT

Author¡ty: Pußuant to 5 U.S-C. chapters 1 1 and 79, and in discharging the funct¡ons direcled under Execut¡ve O¡der 14043, Regu¡r¡ng Coronavirus Disease 20l9VaccinationforFederal Employees(Sept.9,2021),DoDisauthorizedtocolleclthisinformation. Additional authorit¡esforthesystêmsofrecords assoc¡atad with this collection of inñomation also include: E.O. 13991, Prot€ct¡ng the Fsderal Worldorce and Requiring Mask-Wsaring; E.O. 12196. Occupational Safety and Health Program for Federal Employees; 10 U.S.C. 1 13, 10 U.S.C. 136. 10 U.S.C. 7013, 10 U.S.C. 8013, 10 U.S.C. 9013. 10 U.S.C. 2672: DoD D¡rective 5525.21; and DoD lnstruction 6200.03. Providing this information is mandatory, and DoD is authorized to impose penalties for failure to prov¡de the information pursuant to appl¡æble Federal personnel larc and regulat¡ons.

PrincipalPurpose: Thisinformationisbe¡ngcollectedandma¡ntainedto¡mplementCoronavirusDisease20lg(COVID-19)workplacêsafetyplans.and ensure the safety and protect¡on of the DoD worKorce, workplace, and othêr DoD facilities and environments, consistent with the abovê-rôferencod authorities, the COVID-19 WorkPlace Safety: Agency Model Safety Principles established by the Safer Federal Workforæ Task Force. and guidance from the Centeß for Disease Control ênd Prevention and the Occupat¡onal Safety and Hælth Adm¡n¡strat¡on.

Routlne Use(s): While the information rêquest€d on this fom is intended to be used primarily for ¡ntemal purposes, in certain circumstanc€s it may be necessary to d¡sclose th¡s information extemally, for example to d¡sclose ¡nformation to: a peßon, organizat¡on or govemmental entity as necessry and relevant to notify th€m of, respond to, or guard aga¡nst a public hælth emergency, or other similar crisis, includ¡ng to comply with laws governing the reporting of commun¡cable disease or other laws concerning health and sfêty in the work env¡ronment; âdjudicat¡vê bodies (ê.g., the Merit System Protection Board), arbitratoß, and hear¡ng examiners to the extent necessary to carry out the¡r authorized duties regarding Federal émployment; æntractors, grantees, experts.

consultants, students, and others as necessary to perform thêir duties for the Federal gov€mment: or agencies. courts. and persons as nècessary and relevant in the course of litigat¡on, and as necessary and in accordance with requirements for law enforcement; or to a peßon authorized to act on your behalf.

A comPlete list of routine uses may be found in the applicable System of Records Notiæ (SORN) asoc¡ated w¡th the collection of his infiomation as follows:

FormostFedèralcivilianemployees: OPM/GOW-I0,EmployeeMedicalFileSystemRecords,TSFed.Reg.350gg(Jun.21,z}1}),amended80Fed.Reg.

74815(Nov.30,2015). ForFederalciv¡¡¡anemployeesnotcoveredbyOPÍ\,UGOW-10: DPR39DoD,DoDPersonnelAccountabilityandAssessmentSystemôf Rêcords, 85 Fed. Rsg. 17047 (Mar.26,2020) (also ava¡lable at https://dpcld.defense.gov/Portals/491DæumentlPrivacy/SORNs/OSDJS/DPR-39-DoD.pdf).

Consequencès of Fallure to Provlde lnlormadon: Providing this informalion is mandatory. Unless granted an exêmption, all covered Federal civilian employees are required to be vacc¡nated against COVID-19. Employees are requ¡red to prov¡de documentation oncern¡ng their vaccinat¡on status to their employing DoD Component. Failure to provide this infomation may subject you to disciplinary action, including and up to removal from Federal service.

INSTRUCTIONS: Sect¡on A of th¡s form should be completed by DoD civilian employæs only. Sêction B of th¡s frcm should be complêted by thê DoD civilian emPloyêe's supêruisor (or authorized human re$urces ofücial). This fom should be completed by OoD c¡vilian employees only. Seryice members and employees of DoD contrac{ors should nol complete this form.

SECTION A. To be completed Þy DoO civil¡an employees.

1. CIVILIAN EMPLOYEE NAME (Last, Firet. Ml): 2. CIVILIAN EMPLOYEE DoD ID NUMBER:

3, PLEASE CHECK ALL THAT COINCIDES WITH YOUR COVID.1g VACCINATION STATUS:

[-l S.a. I am tully vaccinated.! lndividuals ar6 considered'fully vaccinated" two weeks after completing the seænd dose of a twodose COVID-1g vacc¡ne or two weeks after ræeivingasingledoseofaonedosevaccine. AccêptedCOV|D-19vacc¡nesarethosewhichhavereceivedalicenseorêmêrgencyuse authorization from the U.S. Food and Drug Adm¡n¡stration and those COVID-I9 vaccines on the World Health Organ¡zation Emergency Use Listing.

"Fully vaæinated" also ¡ncludes circumstances in which the ¡ndiv¡dual was a partic¡pant ¡n a U.S. s¡te clinical trial and has received all recommended doses.

fl S-0. I have ræeived one or mor€ doses. but I am notyet ænsidered fully vacc¡nated (in acærdanæ with the definitim of fully vaccinated above).tl

| | S.". t have submitted proof of vaæination to my superu¡sor.

Proof of vaccination includes a copy of ihe record of immunization from a health care provider or pharmacy. å copy of the COVID-19 Vaccination Re@rd Card, a copy of mediæl ræords documenting the vacc¡nat¡on, a copy of immunizat¡on records ftom a public hêalth or state immuniätion ¡nformation system, or a copy of any other official documentalion. Employees may provide a digital copy of such records. including, for example, a digital photograph, scanned image, or PDF of such a record that is clear and legible.

f--] S.¿. I have not rec6iv6d anv vaccinat¡on doses.LI fl S... I have submitted a requast for an exemption from vaccination and a decision is slill pending.LI

| | S.t. t have an approved exempt¡on from vacc¡nat¡on.LJ

CUI (when filled in) Controlled by: OUSD(P&R) Page Controlled by ASD(HA) CUI Category: HLTH PRVCY, OPSEC LDC: DL(DoO Only) POC. osd.penlagon.ousd-o-r.mbx.foms{A'nìail. mil

DD FORM

CUI (when filled in)

CUI (when filled in)

4. EMPLOYEE VACCINE INFORMATIQN (Employæs cheÇking block 3.a. should skip block 4 and go to block 5):

4.a. VACCINE MANUFACTURER(S) OR VACCINE PRODUcT NAME(S):

Ll Pfizer-BioNTech/Comimaty t I Moderna n Astrazeneca/Oxford n Johnson ând Johnson iJ&J)/Janssen

I I Novavax

Other U.S- Food and Drug Adm¡nistration l¡cenæd or author¡zed.

| ] World Health Organ¡zat¡on Emergencv Uæ l¡sled vaccine or U.S. site clinical trial vaccine (provitle name):

5, CERTIFICATION/KNOWLEDGE OF POSSIBLE ACTIONS FOR FALSE STATEMENTS

4.b, OATE OF FIRST DOSE:

4.c. DATE OF SECOND DOSE (if two4ose vaccine):

4.d. DATE FULLY VACCINATED:

I certify that the ¡nformation I have provided on his form and the proof of vacc¡nation documentâtion I havè submitled is true and corect.

I understand that a knorving and willful false statement on this form cÊn be punished byfne or imprisonmentor both (18 U.S.C. 1001). I understand that making a false statement on this fom could result ¡n additional admìnistrat¡ve act¡on includ¡ng an adverse persnnêl action up to and including rêmoval fiom my posit¡on.

6. CIVILIAN EMPLOYEE SIGNATURE:

G

7. DATE:

SECTION B. To be completëd by the supervlsor of the DoD clvlllan employee completlng sectlon A (or an authorlzed human resources olflclal)

8. SUPERVISOR PROOF OF VACCINATION REVIEW

! 8.a. Prcøotvacc¡nation not reæived.

[ 8.b. Proof of vaccinat¡on received and under rêvièw.

[ 8.c. Proof of vaccination rêæived and reviewed.

9, STATUS OF VACCINATION. EXEMPTION REVIEW

n 9.a. Exempt¡on rêquest reæ¡ved and pending disposition.

n 9.b. Exêmption request ræeived and approved.

n 9.c. Ex€mption request râcâivêd and dêni€d.

n 9.d. Exempt¡on rêquest not ræe¡ved.

10. SUPERVISOR /AUTHORIZED HR OFFICIAL NAME (Last, First, M!): 11. SUPERVISOR / AUTHORIZED HR OFFICNL DoD ID NUMEER:

12. SUPERVISOR / AUTHORIZED HR OFFICIAL SIGNATURE:

D

13. DATE:

PREVIOUS EDITION IS OBSOLETE.

CONTRACTOR PERSONNEL AND VISITOR CERTIFICATION OF VACCINATION O^48 No.07044613 ExttEîoa: ,220228

AGENCY DISCLOSURE NO]ICE

The publ¡c repqting burden for this cdlect¡m of information is estimated to average 2 minutes per response, ¡ncluding the time fü reviewing ¡nstructids, searching ex¡st¡ng data sdrces, gather¡ng and maintaining the data needed, and cmpleting and reviewing the collectim of ¡nfomation. Send cmments reg8rding th¡s burden eslimate or 8ny other aspect ofth¡s collectio of informat¡orì, ¡ncluding suggestifis for reducing the burden, to the Department of Defense, Washington Headquarters Seruices, at whs.mc-alex.esd.mbx.d+dod-¡nformationcdlections@ma¡l.mil, Respondents should be aware that ndwithstand¡ng any other prdisiorì of law, no peFon shall be subject to any penalty for fai¡ing to comply with a collect¡m of informatim ¡f it dæs nd d¡splay a currenlly valid OMB cdtrol number.

PRIVACY ACT STATEITI ENT

Authorfty: OoD is author¡zed to cdlect the ¡nformat¡on orì this form pursuant to Executive Order (E.O;) 14042, Ensur¡ng Adequate COVID Safety Protocds for Federal Contractors; E.O. 13991, Protect¡ng the Federal Workforce and Requiring Mask-Wearing; and E.O. 12196, Occupatiorìal Safetyand Health program for Federal Employees; aswell as 10 U.S.C. f'13,10 U.S.C.136, 10 U.S.C.7013,10 U.S.C.8013,10 U.S.C.9013.10 U.S.C.2672.5 U.S.C. chapterTg, and DoD lnstruct¡on 6200.03.

P¡inc¡pal Purposs: Th¡s infomat¡tr ¡s being cdlected to ¡mplement Cqdavirus Disease 2019 (COMF19) workplace safety plans, ¡nclud¡ng DoD's COVIDlg testing programs. and to ensure the safety and protect¡on of the DoD wdkfdce, wdkplace, and other DoD facilities and environments, cms¡stent with the abwe-referenced authorit¡es, the COVID-19 Workplace Safety: Agency Model Safety Princ¡ples established by the Safer Federal Wqkforce Task Force, and gu¡dance f¡orn the Centers for Disease Cmtrd and Prevent¡on and the OccupatÌonal Safety and Health Adm¡nistrat¡on.

Routlne Use(s)Ì While the informat¡on requested on this form is intended to be used primarily for ¡nternal purposes, in certain c¡rcumstances it may be necessary to disclce th¡s ¡nformatiorì externally, fq example to d¡sclose information to: a person, otganization, or gcì/emmental entity as necessary and relevant to not¡ry them of, respmd to, or guard aga¡nst a public health emergency or other similar crisis, includ¡ng to cmply w¡th laws goveming the report¡ng of cmmunicable disease or dher laws conceming health and safety ¡n the work envirmment; adiudicat¡ve or administrative bod¡es or ofñcials when the records are relevant and necessary to an adjudicative or admin¡stmtive proceeding; cmtractds, grantees, experts, consultants, students, and others as necessary to perform their duties fd the Federal go/ernment; agencies, courts, and persons as necessary and relevant ¡n the course of ¡itigation, and as necessary and in accordance w¡th requirements for law enfdcement: or to a person authorized to act m ydJr behafi. A cornplete list of riltine uses may be found in the appl¡cable System of Records Notice (SORN) assæiated with the collect¡dì of this ¡nfomation torn corìtractor persmnel and DoD visitors: DPR 39 DoD. DoD Persmnel Accountability and Assessment System of Records, 85 Fed. Reg. 17047 (Mar. 26, 2020) (also available at https://dpcld.defense.gov/Porta¡s/49./ DæumentslPr¡vacy/SO R NsiOSDJS/DPR-39 DoD.pdf).

Cons€quoncss of Fa¡ luro to Provide lnformat¡on: Provjding this ¡nftrmat¡d is vduntary. However, ¡f yd fa¡l to provjde this informatim, you w¡ll be treated as not tully vacc¡nated for purpo6es of ¡mplementing safety measures, including subject to COVIDI 9 screen¡ng test¡ng and/or denied access to DoD fac¡lities.

Fâilure to provide such ¡nformation may also h¡nder DoD's ability to implement COV|Fl9 wdkplace safety plans, thereby increasing the health or safety risk to DoDafüliated personnel and DoD fac¡l¡ties.

INSTRUCTIONS: This form shflld be cornpleted by DoD cotmctor persorìnel and officialvisittrs in accordance with current DoD Fdce Health Protection GuidÊnce. DoD c¡vilian employees should not cornplete this fm.

1. NAMEILâs{, FlßlMt)l 2. DoD lD NUMBER

3. PLEASE CHECK THE BOX BELOW THAT COINCIDES wlTH YOUR COVID-I9 VACCINANON STATUS :

f-l I am tully vacc¡nated.tJ lndividuals are cons¡dered Tully vacc¡nated" two weeks aner completing the secoûd dose of a twùdose COVID-19 vaccine or two weeks ater receiving a single dose of a one-dæe vacc¡ne. Accepted COVID1g vaccines are th6e wh¡ch have received a l¡cense or emergency use authqizat¡on frm the U.S. Food and Drug Admin¡strat¡m and those COVIÞ19 vacc¡nes on the Wodd Health Organ¡zat¡on Emergency Use List¡ng.

'Fully vaccinated" also ¡ncludes circumstances ¡n wh¡ch the ¡ndividual was a part¡cipant ¡n a U.S. s¡te clinical trial and has received all recmmended dæes.

f-l lamnotyetfullyvacc¡naled. lreceivedmlyonedoseofanacceptedtwo-doseCOV|D-19vacc¡ne,dlreceivedmyinal doseofanacceptedCOV|D-19U vaccine less than two weeks ago.

f_l I have not been vaccinated.

LI

J._l I declinetoresoond-tl lnd¡viduals who choose not to cornplete the form will be assumed to be nd fully våcc¡nated fq purposes of applicatiorì of the safety protæols. lf you are not vacc¡nated due to med¡cal or rel¡g¡ous reasons, please check either 'l have not been vaccinated' or "¡ decline to resptrd.' Note that ¡fyou have already received one dce of a wcc¡ne, but are not yet fully vacc¡nated, or if ydJ received yor final dose less than two weeks ago, then you will be treated as not fully vacc¡nated until you are at least two weeks past ydr fnsl dose and resubmit ydr vaccinatiff infsmat¡on.

f-] lcert¡rythattheinfomat¡nprovided¡nthisfmisaccurateandtruetothebestofmyknowledge.tl

I understand that a knil¡ng and w¡lltul false statement s th¡s form can be punished by fine d ¡mprisonment or both (18 U.S-C. 1001). Check¡ng "l decl¡ne to respond" does not constitute a false statement.

4. DATE (YYVYÃüMDD) 5. SIGNATU RE lFør, l'raræ)

ATTACHMENT 4

DD Form 3150 - "Contractor Personnel and Visitor Certification of Vaccination"

GUI (when filled in)

CUI (when filled in) Conbdled by: OUSD(P&R) Contrdl6d by: ASD(HA) CUI Catêgory: HLTH: PRVCY; OPSEC LDC: DL(DoD Only) POC: osd.p6taoon.oùséÞr.ñbx.fqms@meil.mil

3150, OCT 2t'21

I9

I of I

REQUEST FORA MEDICAL EXEMPTION OR DELAY

TO THE COVID-I9 VACCINATION REQUIREMENT

OMB No. 0704461 I Exp.20220430 s@ræs, gathering and ma¡ntaining th€ data needed. and complet¡ng ad reviewing he collætion of inbmd¡on. Send comme¡ts .egard¡ng ùis h¡rdq 6timate or aÍy other asped of this @llection of¡nfo¡mat¡on, ¡ncluding sggegìons br reducing the bu.den, b the Departnent ofDsfense, Whsh¡ngton Headquartqs Seryices, atwhs.mc-alex.esd.mbx.dddo4-inbrmationcoll€ctiüs@mail.mil.