Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vivamus convallis sem tellus, vitae egestas felis vestibule ut.

Error message details.

Reuse Permissions

Request permission to republish or redistribute SHRM content and materials.

Notice of Noncompliance with Mandatory Vaccination Policy




RE: Noncompliance with mandatory vaccination policy

[Company Name] implemented a policy effective [date] requiring all employees to be fully vaccinated against COVID-19 no later than [date]. As of today, you have not provided evidence of your COVID-19 vaccination status and are not in compliance with [Company Name]'s COVID-19 safety policy.

Please choose one of the following options and return this signed form to human resources before [date] :

[Insert a description of available options. The following are examples.

  • Provide valid documentation to human resources that you are fully vaccinated against COVID-19 no later than [date].
  • Submit a request for accommodation for an exception to the vaccination requirement due to a substantiated medical or religious reason no later than [date].
  • Request an unpaid leave of absence of no more than 30 days in order to obtain all required doses of a COVID-19 vaccine.
  • Submit a notice of voluntary resignation effective immediately.]

________________________    ________________________               ________________
Employee name                             Employee signature                                  Date


If you would like to discuss the above options with human resources prior to making a decision, please contact [name and contact information] no later than [date].     

Failure to comply with one of the options above, or to return this form to human resources by [date], will result in disciplinary action, up to and including termination of employment.


​An organization run by AI is not a futuristic concept. Such technology is already a part of many workplaces and will continue to shape the labor market and HR. Here's how employers and employees can successfully manage generative AI and other AI-powered systems.