FormsHome > FormsRequest for Accommodation: Medical Exemption From Vaccination or Wearing of Face MaskFor EmployeeName *Work/Cell Phone *Center/Division *Center/DivisionCreativeIowaKansasLouisianaMarylandMinnesotaNebraskaNew JerseyNorth DakotaOCC CorporateOregonOverflowRelease ManagementSystemsPosition *Gen. Manager/ Dept. Head: *Gen. Manager/ Dept. Head: *Gen. Manager/ Dept. Head: *Gen. Manager/ Dept. Head: *Gen. Manager/ Dept. Head: *Gen. Manager/ Dept. Head: *Gen. Manager/ Dept. Head: *Gen. Manager/ Dept. Head: *Gen. Manager/ Dept. Head: *Gen. Manager/ Dept. Head: *Gen. Manager/ Dept. Head: *Gen. Manager/ Dept. Head: *I am requesting a medical exemption from OCC's vaccination policy for the following:I verify that the information I am submitting to substantiate my request for exemption from OCC’s vaccination/mask policy is true and accurate to the best of my knowledge. I understand that any falsified information can lead to disciplinary action, up to and including termination.I further understand that OCC is not required to provide this exemption accommodation if doing so would pose a direct threat to myself or others in the workplace or would create an undue hardship for OCC.Signature *Start signing your signature hereYour browser does not support e-Signature field.DateFor Medical ProviderAfter pressing submit you will be provided with a pdf. This can be printed or emailed, but the second section must be filled out by your physician and returned to your manager or division leader.SubmitRequest for Accommodation: Medical Exemption from Vaccination or Wearing of FacemaskReligious Accommodation Request Form