Form for USA based Employees Whose Employers Are Requiring Covid-19 Injections

NOTE TO EMPLOYEE: Be sure to document the date and tme you submit this form to your employer; also document the date and tme and their response if they refuse to sign it. NOTE

TO EMPLOYER: As your employee, I am requestng that you review this document, provide the requisite informaton, and sign the form, in regards to your requirement that employees get a Covid19 emergency use authorizaton (EUA) investgatonal vaccine.





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