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Face Covering Exemption Medical Certification Form

Employers should develop a policy to accommodate any worker who meets one of the exemptions from wearing a face mask. If a worker is unable to wear a mask due to a medical condition, they should be provided with a non-restrictive alternative, such as a face shield with a drape attached to the bottom edge, for example. Employers may provide this form to an employee to obtain medical certification from their health care provider supporting their request for an accommodation.