Mercyhealth policy requires all partners to be vaccinated against COVID-19, with exemptions only as required by law. In certain circumstances, partners may hold a religious belief objection to the COVID-19 vaccination requirement. In this case the employee would instead comply with alternative health and safety protocols. Mercyhealth is committed to respecting the important legal protections for religious exemptions. In order to request a religious exemption, please fill out this form. The purpose of this form is to start the exemption process and provide information to Mercyhealth determine whether you may be eligible for a religious exemption.
You do not need to answer every question on the form to be considered for a religious exemption, but we encourage you to provide as much information as possible to enable the agency to evaluate your request. If needed to further clarify the request, Human Resources may ask you for additional information as needed to determine if you are legally entitled to an exemption.
Mercyhealth may consider several factors in assessing whether a request for an exemption is based on a sincerely held religious belief, including whether the partner has acted in a manner inconsistent with their professed belief. No one factor is determinative, rather, an individual’s beliefs—or degree of adherence—may change over time. Therefore, a partners newly adopted or inconsistently observed practices may nevertheless be based on a sincerely held religious belief. All requests for a religious exemption will be evaluated and considered on an individual basis.
Signing this form constitutes a declaration that the information you provide is, to the best of your knowledge and ability, true and correct. Any intentional misrepresentation of a religious declaration to Mercyhealth may result in disciplinary action leading to and including termination.
QUESTIONS:
1. Please describe the nature of your objection to the COVID-19 vaccination requirement.
2. Would complying with the COVID-19 vaccination requirement substantially burden your religious exercise or conflict with your sincerely held religious beliefs, practices, or observances? If so, please explain how.
3. Please provide any additional information that you think may be helpful in reviewing your request.
For example:
• How long you have held the religious belief underlying your objection
• Whether your religious objection is to the use of all vaccines, COVID-19 vaccines, a specific type of COVID-19 vaccine, or some other subset of vaccines
• Whether you have received vaccines as an adult against any other diseases (such as a flu vaccine or a tetanus vaccine)