Edit, Download, and Sign the Maryland DPSCS COVID-19 Exemption Form
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How do I fill this out?
To fill out this form, you need to complete Section I and either Section II for medical exemptions or Section III for religious exemptions. Be sure your information is accurate and follow additional instructions as needed.
How to fill out the Maryland DPSCS COVID-19 Exemption Form?
1
Complete Section I.
2
Fill out Section II for medical exemption.
3
Fill out Section III for religious exemption.
4
Ensure all information is accurate.
5
Submit the completed form to the Office of Equal Employment of Opportunity.
Who needs the Maryland DPSCS COVID-19 Exemption Form?
1
DPSCS employees who require a medical exemption from COVID-19 mandates.
2
DPSCS employees seeking a religious exemption based on bona fide religious beliefs.
3
New employees needing COVID-19 mandate exemptions.
4
Current employees looking to comply with department protocols while following personal beliefs.
5
Employees consulting with medical providers about potential exemptions.
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1
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What are the instructions for submitting this form?
Submit this completed form to the Office of Equal Employment of Opportunity via the provided email address publicsafety.oeo@maryland.gov, or via interoffice mail. Review all information to ensure accuracy and compliance before submission. It's essential to follow submission guidelines and deadlines as provided by your department.
What are the important dates for this form in 2024 and 2025?
Important dates for submission in 2024 and 2025 may vary. Please check with the DPSCS for specific deadlines or guidelines.
What is the purpose of this form?
The Maryland Department of Public Safety and Correctional Services COVID-19 Exemption Form is designed to allow employees to request exemptions from COVID-19 related mandates. It aims to accommodate employees with valid medical or religious reasons for exemption while maintaining the safety and health standards of the department. Employees must complete the necessary sections and provide additional documentation if required. This process ensures compliance with both state and federal guidelines while honoring individual rights.
Tell me about this form and its components and fields line-by-line.
- 1. Section I: Includes the employee's name, date, time, department, reason for exemption, position, and contact information.
- 2. Section II: For medical exemptions, includes certification from a medical provider and identification of specific mandates the exemption applies to.
- 3. Section III: For religious exemptions, includes a statement of bona fide religious belief or practice that the exemption is based on.
What happens if I fail to submit this form?
Failure to submit this form may result in non-compliance with mandatory COVID-19 requirements and potential repercussions.
- Disciplinary Action: Employees may face disciplinary actions for not complying with department mandates.
- Operational Disruptions: Failure to comply may cause operational challenges within the department.
- Health Risks: Non-compliance could increase health risks to employees and the public.
How do I know when to use this form?
- 1. Medical Exemptions: To request exemptions based on valid medical reasons.
- 2. Religious Exemptions: To request exemptions based on bona fide religious beliefs or practices.
- 3. New Employees: New hires needing exemptions from COVID-19 mandates.
- 4. Updated Guidelines: When there are updates to department COVID-19 protocols.
- 5. Annual Review: For periodic review and compliance with exemption requests.
Frequently Asked Question
How do I fill out the COVID-19 Exemption Form?
You need to complete Section I and either Section II for medical exemption or Section III for religious exemption.
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Does PrintFriendly support medical certification?
Yes, you can upload the certification from a medical provider when completing Section II.
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