chs community human services EMERGENCY BOARD OF DIRECTORS MEETING MONDAY, NOVEMBER I, 2O2I l. Approval of the Covid Vaccination Protocol for CHS Employees a, When President Biden mandated Covid vaccinations for all Federal employees, he further ordered it also applies to all Federal contractors. CHS has several Federal contracts which support our programs. CEO Everett McElveen worked with the law firm Blank Rome LLP, Pittsburgh, to develop this policy. The local attorneys worked with one of their firm attorneys in the Washington DC office who specializes in Covid-related issues. b. As the Protocol provides, CHS employees who do not meet specified deadline for proof of vaccination or an approved medical or religious exemption will be separated from the organization. c. lf CHS does not comply with the Federally mandated vaccine provrsions, we would likely lose our federal funds. Accordingly, the Board is requested to approve this Protocol. Action ltem: To approve the CHS Covid Vaccination Protocol Next Board Meetino: Thursdav. November 18. 2021. 4:OO PM Covid Vaccination Protocol As of December 8th,2021., all Community Human Services (CHS) staffwill need to be fully vaccinated due to our partnerships with federal/state and local entities which require us to comply with newly issued government orders mandating covid-19 vaccinations. Each employee of CHS will need to be fully vaccinated which means both doses of the ffizer or Moderna vaccine, or the single dose Johnson & Johnson vaccine and receive their booster for Johnson & Johnson inoculation 2 months after the initlal dose. Vaccine Specific lnformation PfiZgf, " t*o-dose vaccination given 21 days apart with this protocol the first dose cannot be taken later than, Wednesday November 10th, 2021. The second dose due no later than Wednesdav December 1st. This dosing schedule & calculation does not include the two-week post vaccination period in which the antibodies become fully active, and after the two-week period the person is now considered fully vaccinated per CDC Covid Vaccination Guidelines. Please also consider the booster shot available 6 months after your last vaccination dose. MOdgf na, a two-dose vaccination given 28 days apart with this protocol the first dose cannot be taken later than, Wednesday November 3d, 2021. The second dose is due no later than December L't, 2021. This dosing schedule & calculation does not include the two-week post vaccination period in which the antibodies become fully active, and after the two-week period the person is now considered fully vaccinated per CDC Covid Vaccination Guidelines. Please also consider the booster shot available 6 months after your Iast vaccination dose. JOhnSOn & JOhnSOn, a single dose vaccination-the last date with this protocol to receive this vaccination is Novembel 24'h, m2L. This dosing schedule & calculation includes the two- week post vaccination period in which the antibodies become fully active, and the.

1. chs
community human services
EMERGENCY BOARD OF DIRECTORS MEETING
MONDAY, NOVEMBER I, 2O2I
l. Approval of the Covid Vaccination Protocol for CHS
Employees
a, When President Biden mandated Covid vaccinations for all
Federal
employees, he further ordered it also applies to all Federal
contractors. CHS has several Federal contracts which support
our
programs. CEO Everett McElveen worked with the law firm
Blank
Rome LLP, Pittsburgh, to develop this policy. The local
attorneys
worked with one of their firm attorneys in the Washington DC
office who specializes in Covid-related issues.
b. As the Protocol provides, CHS employees who do not meet
specified deadline for proof of vaccination or an approved
medical
or religious exemption will be separated from the organization.
c. lf CHS does not comply with the Federally mandated vaccine
provrsions, we would likely lose our federal funds.
Accordingly,
the Board is requested to approve this Protocol.
Action ltem: To approve the CHS Covid Vaccination Protocol

2. Next Board Meetino: Thursdav. November 18. 2021. 4:OO PM
Covid Vaccination Protocol
As of December 8th,2021., all Community Human Services
(CHS) staffwill need to be fully
vaccinated due to our partnerships with federal/state and local
entities which require us to comply with
newly issued government orders mandating covid-19
vaccinations. Each employee of CHS will need to
be fully vaccinated which means both doses of the ffizer or
Moderna vaccine, or the single dose
Johnson & Johnson vaccine and receive their booster for
Johnson & Johnson inoculation 2 months after
the initlal dose.
Vaccine Specific lnformation
PfiZgf,
"
t*o-dose vaccination given 21 days apart with this protocol the
first dose cannot be
taken later than, Wednesday November 10th, 2021. The second
dose due no later than Wednesdav
December 1st. This dosing schedule & calculation does not
include the two-week post vaccination
period in which the antibodies become fully active, and after the
two-week period the person is now
considered fully vaccinated per CDC Covid Vaccination
Guidelines. Please also consider the booster shot

3. available 6 months after your last vaccination dose.
MOdgf na, a two-dose vaccination given 28 days apart with this
protocol the first dose
cannot be taken later than, Wednesday November 3d, 2021. The
second dose is due no later than
December L't, 2021. This dosing schedule & calculation does
not include the two-week post vaccination
period in which the antibodies become fully active, and after the
two-week period the person is now
considered fully vaccinated per CDC Covid Vaccination
Guidelines. Please also consider the booster shot
available 6 months after your Iast vaccination dose.
JOhnSOn & JOhnSOn, a single dose vaccination-the last date
with this protocol to
receive this vaccination is Novembel 24'h, m2L. This dosing
schedule & calculation includes the two-
week post vaccination period in which the antibodies become
fully active, and the person is now
considered fully vaccinated per CDC Covid Vaccination
Guidelines. Please also strongly consider the
booster shot recommended two months post vaccination.
Please notify People Operations of your vacclnation status/ plan
to be vaccinated no later than
Friday, October 29, 2021. You will also be required to submit
your completed vaccination card to People
Operations, attention Jane Allen ([email protected]). You must
send a copy of your first vaccine dose
on or before the date that corresponds to your selected Covid 19
vaccination to People Operations. You

4. must send a copy of your completed Moderna or ffizer (2
doses), or your Johnson & Johnson
vaccination no later than Novembet 24,z0Z!,for lohnson &
Johnson or December 1" for ffizer or
Moderna, to People Operations.
lf you choose to seek a medical or religious exemption request,
this submission will not negate
the compliance dates. Contact Jane Allen for copies of
exemption request forms. We are requiring that
all requests be submitted no later than wednesday November
3'd, 2021. This submission date will still
allow you to appropriate time for a Covid 19 Vaccination if the
request is not approved.
ICOMPAI{YI
COVID-Ig VACCINE REQUIREMENT
RELIGIOUS EXEMPTION/ACCOMMODATION REOUEST
FORM
Please print a copy of this form, complete all sections, sign, and
email to
xxxxxxxxxx.com. [COMPAI{YI HR will review and contact you
to discuss
and seek additional information and documentation, as needed.
Employee Name Employee ID #:
Department:

5. Phone Number:
Job Title.
This document affirms that the administration of the COVID-l9
vaccine conflicts with my
religious faith tenants, practices and,/or my sincerely held
religious beliefs, and that I am requesting
an accommodation from the vaccination requirements currently
in effect at [COMPANY].
Please identifu your sincerely held religious belief(s),
observance(s), or practice(s) that explain
why you are requesting this exemptior/accommodation and how
long you have adhered to these
belief(s), observance(s), or practice(s)?
Please explain what it is about your belief(s). observance(s) or
practice(s) that prevent you lrom
getting vaccinated for COVID-I9 and necessitates this request.
Please attach any additional
supporting documentation to this request form.
9002m.0000 I/1271 88739v. I
When did you first form the belief(s), observance(s) or
practice(s) that form the basis for your
accommodation request regarding vaccination?
Have you received any vaccinations in the past (e.9. poliq
influenza, DTaP, HPV, Hepatitis B)?
(circle one) Yes No

6. If you have received any prior vaccinations, how do those
vaccines differ from the COrlD-l9
vaccines in the context ofyour beliefs?
900200.00001 /1 271 88739v. 1
2
Have you taken any prescription or over-the-counter medication
since forming the beliefs that
form the basis for your accommodation request regarding
vaccination? (circle one)
Yes No
Ifyou have taken medication since forming yourbeliefs, how do
those medications differ from the
CO{D-19 vaccines in the context ofyour beliefs?
Identify the accommodation(s) you are requesting and the
applicable time period.
Please provide any additional information that may be helpful in
processing your religious
exemption/accommodation request.
I confirm that the information I have provided is accurate and
truthful to the best of my knowledge.
I also understand that dishonesty may result in disciplinary
action, including employment
termination.

7. Signature: Date:
900200.00001/127188739v. 1
Employee Medical Exemption/Accommodation Request -
COVID-19 Vaccine
COMPANY ("Company") is committed to providing equal
employment opportunities and a place of
employmentthat does not allow unlawful harassment,
discrimination, and retaliation. Our Company is
committed to complying with all laws protecting individuals
with disabilities or medical conditions- The
Company will review requests for an exemption/reasonable
accommodation for any known medical
condition or disability of a qualified individual which prevents
them from receiving a COVID-19 vaccine.
Requests will be approved when reasonable and that do not
create an undue hardship for the Company
and/or pose a direct threat to the health or safety of others in
the workplace and/or to the requesting
employee.
To request an Exemption/Accommodation related to the
Company's COVID-19 vaccination policy, please
complete Part 1 of this form, have your healthcare provider
complete Part 2 (the certification portion),

8. and return them to Human Resources. This information will be
used by Human Resources or other
appropriate personnel to engage in an interactive process to
determine whether an employee is eligible
for such exemption/accommodation and if so, to determine the
reasonable accommodations which can
be provided that would enable the employee to perform the
essential functions of their position
without posing a threat of harm to self or others. lf an employee
refuses to provide such information,
the employee's refusal may impact the Company's ability to
adequately understand the employee's
request or to effectively engage in the interactive process to
identify possible accommodations.
ln order to be properly submitted, the request must include the
written certification completed by a
licensed, treating medical provider, of one of the following:
1. The applicable CDC symptom or condition that makes receipt
of the COVID-19 vaccine a medical
risk, or
2. A statement that the physical condition of the person or
medical circumstances relating to the
person are such that immunization is not considered safe,
indicating the specific nature and
probable duration of the medical condition or circumstances
that contraindicate immunization
with the COVID-19 vaccine.
900202.tr)221 I 1 2597 52O3v 2

9. SECTION l- Employee to Complete the Following:
Name:
Date of Request:
Type of Request and Reason:
Verification and Accuracv
I verify that the information I am submitting in support of my
request for an accommodation is
complete and accurate to the best of my knowledge, and I
understand that any intentional
misrepresentation contained in this request may result in
disciplinary action.
I also understand that my request for an accommodation may
not be granted if it is not
reasonable, if it poses a direct threat to the health and/or safety
of others in the workplace
and/or to me, or if it creates an undue hardship on the Company.
Signature:
Date:
Print Name:
9O02O2.U)221 / 125975203v .2
SECTION ll -Employee's Medical Provider to Complete the

10. Following:
Company Name:
Employee Name:
Medical Provider:
COMPANY requires a COVID-19 vaccination. The employee
listed above is requesting an
exemption from this vaccination requirement. A medical
exemption from the COVID-19
vaccination may be allowed for certain recognized medical
conditions.
Please complete the form below. Should you have any
questions, please contact
. Thank you.
The above pe6on should not be immunized for COVID-19 for
the following reasons (Please
check all that apply.):
f_l History of previous allergic reaction to indicate an
immediate hypersensitivity reaction to a
component of the vaccine-
l-l The physical condition of the person or medical
circumstances relating to the person are
such that immunization is not considered safe. Please indicate
the specific nature and
probable duration of the medical condition or circumstances

11. that contraindicate
immunization with the COVID-19 vaccine.
I-_l other - Please provide this information in an attached
explanation that describes the
exemption in detail.
I certify that has the above medical condition and verify the
request a
medical exemption from the COVID-19 vaccination.
Medical Provider Signature:
Date:
Print Name:
Address:
Phone number:
900202 0022 1 1 1 2597 5203v.2
SECTION lll - Company Review of Request/ HR Only:
Date this Request Form Received in
lnteractive Discussion Date(s) if applicable:
Exemption/Accommodation granted?
Describe Exemption/Accommodation:

12. .Yes _ No
lf Exemption/Accommodation granted, list required ahernative
safety precautions required:
Name of Representative:
Signature of Representative:
Date:
9 00202. (n 22 U I 2 s 97 5203 .2