A form for federal employers to use with employees requesting an exception to the requirement that all federal employees be vaccinated against COVID-19 because of a disability. This Standard Document applies to federal agency workplaces. Executive Order 14043 was enjoined therefore this medical exception was not necessary while the nationwide injunction was in place. On May 9, 2023, President Biden issued an Executive Order (EO) on Moving Beyond COVID-19 Vaccination Requirements for Federal Workers, revoking EOs 14042 and 14043 effective May 12, 2023. Agency policies adopted to implement EOs 14042 and 14043, may no longer be enforced and shall be rescinded consistent with applicable law.

This Standard Document is based on a template drafted by the Safer Federal Workforce Task Force and is based on federal law. This Standard Document has integrated notes with important explanations and drafting tips.