Title:

COVID-19 Vaccination, Testing and Face Covering

Effective Date:                                                           

February 11, 2022

 

Who Can Report to Work (effective Feb. 16, 2022) —> see below

Policy Statement:

Donald Martens and Sons Ambulance Service, Inc. is requiring all of our employees to conduct regular COVID-19 testing or be vaccinated in accordance with the deadlines provided in this policy.  Employees who have been granted exemptions from the COVID-19 vaccine or those for whom COVID-19 vaccination must be temporarily delayed (as recommended by CDC), are not required to be vaccinated.

COVID testing and face covering requirements for non-vaccinated employees are effective February 16, 2022.  Home tests will be accepted.

To be up to date with COVID-19 vaccinations by April 15, 2022, an employee must:

  • Obtain the first dose of a two-dose vaccine no later than February 16, 2022; and the second dose no later than March 15, 2022; or
  • Obtain one dose of a single dose vaccine no later than February 16, 2022;

Purpose:

Many of our employees have received the vaccine since it has become available and we continue to encourage those who are not yet vaccinated to receive their vaccine as quickly as possible.

Vaccination is a vital tool to reduce the presence and severity of COVID-19 cases in the workplace, in communities, and in the nation as a whole.  Donald Martens and Sons Ambulance Service has adopted this policy on mandatory vaccination to safeguard the health of our employees from the hazard of COVID-19.  Martens Ambulance is committed to providing first-class patient care and service excellence.  Vaccination of employees, along with other workplace safety procedures will contribute to the safety of our patients, workers’ families, customers and visitors, business partners, and the community.

Scope:

This COVID-19 Vaccination, Testing and Face Covering Policy applies to all employees of Donald Martens and Sons Ambulance Service (except for those who have been granted exemptions from the COVID-19 vaccine or those for whom COVID-19 vaccination must be temporarily delayed, as recommended by the CDC.

 Medical and Religious Exemptions

Employees may request an exception from this vaccination policy if the vaccine is medically contraindicated for them or medical necessity requires a delay in vaccination. Employees also may be legally entitled to a reasonable accommodation if they cannot be vaccinated and/or wear a face covering (as otherwise required by this policy) because of a disability, or if the provisions in this policy for vaccination, and/or testing for COVID-19, and/or wearing a face covering conflict with a sincerely held religious belief, practice, or observance. Requests for exceptions and reasonable accommodations must be initiated by the employee by February 16, 2022 (or within the first 30 days of employment for employees hired after the effective date of this policy).  All such requests will be handled in accordance with applicable laws and regulations and the employer’s applicable policies and procedures.

Medical exemptions from COVID-19 vaccination are to be submitted in writing from a licensed practitioner, who is not the individual requesting the exemption, and who is acting within their respective scope of practice as defined by, and in accordance with all applicable State and local laws, and for further ensuring that the documentation contains:

  • All information specifying which of the authorized COVID-19 vaccines are clinically contraindicated for the staff member to receive and the recognized clinical reasons for the contraindications; and
  • A statement by the authenticating practitioner recommending that the staff member be exempted from COVID-19 vaccination based on the recognized clinical contraindications.

Requests for religious exemption may be submitted for consideration with the form in this policy (ref. Addendum III).

No exemption will be provided to any staff for whom it is not legally required (under the ADA or Title VII of the Civil Rights Act of 1964) or who requests an exemption solely to evade vaccination.

 

Procedures:

Overview and General Information

All Donald Martens and Sons Ambulance Service employees must be fully vaccinated no later than April 15, 2022.

To be up to date with COVID-19 vaccinations by April 15, 2022, an employee must:

  • Obtain the first dose of a two-dose vaccine no later than February 16, 2022; and the second dose no later than March 15, 2022; or
  • Obtain one dose of a single dose vaccine no later than February 16, 2022;
  • Obtain additional doses, if mandated by the CDC in the future.

Employees who are not vaccinated (or who have not been granted exemption) by the above deadlines will be removed from the work schedule and placed on an administrative leave of absence without pay for a maximum of 90 days after which the final status of employment will be determined.

Employees will be considered fully vaccinated two weeks after receiving the requisite number of doses of a COVID-19 vaccine. An employee will be considered partially vaccinated if they have received only one dose of a two-dose vaccine.

Employees may schedule their vaccination appointments through local pharmacies, through their own medical provider, or with a mass-vaccination clinic.  Human Resources will be maintaining this policy and a secure database of employee vaccination and testing dates.  Employees must submit their vaccination and testing documentation to Human Resources.

Time off

If an employee should need time off to obtain the COVID-19 vaccine or to recover from side effects,   inform your supervisor in advance of any pre-scheduled time to obtain the vaccine and of any time off required due to side effects by following the standard procedures for requesting time off, or calling off (ref. Absenteeism and Tardiness policy).

Vaccination Status and Acceptable Forms of Proof of Vaccination

All vaccinated employees are required to provide proof of COVID-19 vaccination, regardless of where they received vaccination. Proof of vaccination status can be submitted via email to HR @Martensambulance.com or in-person at the HR office.

Acceptable proof of vaccination status is:

  1. The record of immunization from a healthcare provider or pharmacy;
  2. A copy of the COVID-19 Vaccination Record Card;
  3. A copy of medical records documenting the vaccination;
  4. A copy of immunization records from a public health, state, or tribal immunization information system; or
  5. A copy of any other official documentation that contains the type of vaccine administered, date(s) of administration, and the name of the healthcare professional(s) or clinic site(s) administering the vaccine(s).

Proof of vaccination generally should include the employee’s name, the type of vaccine administered, the date(s) of administration, and the name of the healthcare professional(s) or clinic site(s) that administered the vaccine. In some cases, state immunization records may not include one or more of these data fields, such as clinic site; in those circumstances Donald Martens and Sons Ambulance Service will still accept the state immunization record as acceptable proof of vaccination.

If an employee is unable to produce one of these acceptable forms of proof of vaccination, despite attempts to do so (e.g., by trying to contact the vaccine administrator or state health department), the employee can provide a signed and dated statement attesting to their vaccination status (fully vaccinated or partially vaccinated); attesting that they have lost and are otherwise unable to produce one of the other forms of acceptable proof (use the form Addendum I Employee Attestation Lost COVID-19 Vaccination Status).  An employee who attests to their vaccination status in this way should, to the best of their recollection, include in their attestation the type of vaccine administered, the date(s) of administration, and the name of the healthcare professional(s) or clinic site(s) administering the vaccine.

Employee Notification of COVID-19 and Removal from the Workplace

Donald Martens and Sons Ambulance Service will require employees to promptly notify their supervisor when they have tested positive for COVID-19 or have been diagnosed with COVID-19 by a licensed healthcare provider.

Inform your supervisor immediately and follow the standard procedures for requesting time off, or calling off (ref. Employee Testing Policy During COVID-19 Pandemic, and Absenteeism and Tardiness policy).

Medical Removal from the Workplace

Donald Martens and Sons Ambulance Service has also implemented a policy for keeping COVID-19 positive employees from the workplace in certain circumstances. Donald Martens and Sons Ambulance Service will immediately remove an employee from the workplace if they have received a positive COVID-19 test or have been diagnosed with COVID-19 by a licensed healthcare provider (i.e., immediately send them home or to seek medical care, as appropriate).

Return to Work Criteria

For any employee removed because they are COVID-19 positive, Donald Martens and Sons Ambulance Service will keep them removed from the workplace and may return to work in accordance with the most recent guidelines established by the CDC.

Under CDC’s “Isolation Guidance,” (at the time of writing this policy) asymptomatic employees may return to work once 5 days have passed since the positive test, and symptomatic employees may return to work after all the following are true:

  • At least 10 days have passed since symptoms first appeared, and
  • At least 24 hours have passed with no fever without fever-reducing medication, and
  • Other symptoms of COVID-19 are improving (loss of taste and smell may persist for weeks or months and need not delay the end of isolation).

If an employee has severe COVID-19 or an immune disease, Donald Martens and Sons Ambulance Service will follow the guidance of a licensed healthcare provider regarding return to work.

If the employee qualifies for FMLA, that procedure will apply (ref. Employee Handbook, Leave of Absence, Policy for Family and Medical Leave).

COVID-19 Testing

If an employee covered by this policy is not fully vaccinated, they will be required to provide proof of a negative test in accordance with the testing frequency mandated in that specific period.  At this time, if the employee is granted an exception from the mandatory vaccination requirement because the vaccine is contraindicated for them, or have a valid religious exemption), the employee will be required to comply with this policy for testing.

Employees who report to the workplace at least once every seven days:

(A) must be tested for COVID-19 at least once every seven days; and

(B) must provide documentation of the most recent COVID-19 test result to the supervisor no later than the seventh day following the date on which the employee last provided a test result.  The supervisor is responsible for promptly forwarding the documentation to Human Resources.

Example:   COVID-19 testing documentation must be on file verifying the employee has been tested once every seven days and the employee cannot work if the most recent COVID-19 test is at the 7th day or older.

Any employee who does not report to the workplace during a period of seven or more days (e.g., PRN employees):

(A) must be tested for COVID-19 within seven days prior to returning to the workplace; and

(B) must provide documentation of that test result to the supervisor upon return to the workplace.  The supervisor is responsible for promptly forwarding the documentation to Human Resources.

Example:   The employee cannot report to work unless they have proof of a COVID-19 test done within the past 7 days.  The employee cannot work if the most recent COVID-19 test is at the 7th day or older.

If an employee does not provide documentation of a COVID-19 test result as required by this policy, they will be removed from the workplace until they provide a negative test result.  The employee will be placed on leave of absence and the employment status reviewed periodically.  If the employee has accrued PTO, it will be paid until exhausted.  Otherwise, the leave of absence will be without pay.

Employees who have received a positive COVID-19 test, or have been diagnosed with COVID-19 by a licensed healthcare provider, are not required to undergo COVID-19 testing for 90 days following the date of their positive test or diagnosis.

Face Coverings

If an employee covered by this policy is not fully vaccinated (e.g., if they are granted an exception from the mandatory vaccination requirement because the vaccine is contraindicated for them), Donald Martens and Sons Ambulance Service will require the employee to wear a face covering. Face coverings must:

  • Meet healthcare infection control PPE standards for employees interacting with patients and care givers at healthcare facilities and comply with N-95 fit testing standards.
  • Completely cover the nose and mouth;
  • For office-based staff and individuals not interacting with patients and care givers at healthcare facilities, be made with two or more layers of a breathable fabric that is tightly woven (i.e., fabrics that do not let light pass through when held up to a light source);
  • Be secured to the head with ties, ear loops, or elastic bands that go behind the head. If gaiters are worn, they should have two layers of fabric or be folded to make two layers;
  • Fit snugly over the nose, mouth, and chin with no large gaps on the outside of the face; and
  • Be a solid piece of material without slits, exhalation valves, visible holes, punctures, or other openings. Acceptable face coverings include clear face coverings or cloth face coverings with a clear plastic panel that, despite the non-cloth material allowing light to pass through, otherwise meet these criteria and which may be used to facilitate communication with people who are deaf or hard-of-hearing or others who need to see a speaker’s mouth or facial expressions to understand speech or sign language respectively.

Employees who are not fully vaccinated must wear face coverings over the nose and mouth when indoors and when occupying a vehicle with another person for work purposes.

Employees may wear their own face covering provided it is consistent with the criteria listed above or the employee can wear a face covering provided by Donald Martens and Sons Ambulance Service.

The following are exceptions to Donald Martens and Sons Ambulance Service requirements for face coverings:

  1. When an employee is alone in a room with floor to ceiling walls and a closed door.
  2. For a limited time, while an employee is eating or drinking at the workplace or for identification purposes in compliance with safety and security requirements.
  3. When an employee is wearing a respirator or facemask.
  4. Where Donald Martens and Sons Ambulance Service has determined that the use of face coverings is infeasible or creates a greater hazard (e.g., when it is important to see the employee’s mouth for reasons related to their job duties, when the work requires the use of the employee’s uncovered mouth, or when the use of a face covering presents a risk of serious injury or death to the employee).

New Hires:

All new employees are required to comply with the vaccination requirements outlined in this policy as soon as practicable and as a condition of employment.  Potential candidates for employment will be notified of the requirements of this policy prior to the start of employment and must provide proof of vaccination, or religious or medical exemption, during the onboarding clearing process as a requirement to begin work.

Confidentiality and Privacy:

All medical information collected from individuals, including vaccination information, test results, and any other information obtained as a result of testing, will be treated in accordance with applicable laws and policies on confidentiality and privacy.

Questions:

Please direct any questions regarding this policy to the Human Resources Department via email HR@martensambulance.com, or tel. 440-260-3755.

 

Who Can Report to Work (effective Feb. 16, 2022)

Your status COVID Test Wear a Mask Report to Work
Fully Vaccinated (or, “up to date” with CDC recommended number of doses) ——-> Only if symptomatic, or recommended due to exposure In accordance with PPE standards in healthcare environments Yes
Partially Vaccinated ——-> Yes, required Yes, required Only if COVID testing is not expired, and test result is negative
Not Vaccinated, and has Medical or Religious Exemption ——-> Yes, required Yes, required Only if COVID testing is not expired, and test result is negative
Not Vaccinated and no Medical or Religious Exemption ——-> No
After Testing Positive for COVID ——-> Not required for 90 days after onset of COVID In accordance with PPE standards in healthcare environments After 5 days if not symptomatic.
After 10 days if symptom-free, 24 hours without fever, and other COVID symptoms are improving.

 

________________________________________________________________________

Addendum I

Employee Attestation Lost COVID-19 Vaccination Status

 

I have lost, and are otherwise unable to produce one of the following forms of acceptable proof of vaccination:

  1. The record of immunization from a health care provider or pharmacy;
  2. A copy of the COVID-19 Vaccination Record Card;
  3. A copy of medical records documenting the vaccination;
  4. A copy of immunization records from a public health, state, or tribal immunization information system; or
  5. A copy of any other official documentation that contains the type of vaccine administered, date(s) of administration, and the name of the health care professional(s) or clinic site(s) administering the vaccine(s).

 

Date(s) of Vaccination: 1st dose: __________________  2nd dose: ______________________

 

Vaccination Manufacturer: ____________________________________________________

 

Place of Vaccination: _________________________________________________________

 

“I declare that I have attempted to obtain a copy of my COVID-19 Vaccination card by contacting the vaccine administrator or state health department, and despite attempts to do so, this statement about my vaccination status is true and accurate.  I understand that knowingly providing false information regarding my vaccination status on this form may subject me to criminal penalties.”

Employee Name:  (print clearly) __________________________________________________

Employee Signature: ___________________________________________ Date: __________

 

 

___________________________________________________________________________________

Addendum II

Employee Attestation

COVID-19 Vaccination Card Validation

 

I have produced one of the following forms of acceptable proof of vaccination (check one):

 

____     The record of immunization from a health care provider or pharmacy;

____     A copy of the COVID-19 Vaccination Record Card;

____     A copy of medical records documenting the vaccination;

____     A copy of immunization records from a public health, state, or tribal immunization information system; or

____      A copy of any other official documentation that contains the type of vaccine administered, date(s) of administration, and the name of the health care professional(s) or clinic site(s) administering the vaccine(s).

 

“I declare that copy of my COVID-19 Vaccination card is true and accurate.  I understand that knowingly providing false information regarding my vaccination status on this form may subject me to criminal penalties.”

 

Employee Name:  (print clearly) ______________________________________________________

Employee Signature: ____________________________________________ Date: ______________

 

 

 

____________________________________________________________________________________

Addendum III

Religious Accommodation Request Form

Applicant or Employee Name: ______________________________________

Date of request: _______________Email Address: _________________________

Telephone: _________________________

Employees Position: ___________________________________

Work Location: _______________________________________

Title VII of the Civil Rights Act of 1964 (Title VII), prohibits employment discrimination based on religion.

I am requesting an exception to: Check which box applies:

  • a COVID-19 vaccination requirement for employment

 

  • other job requirement _____________________________________

My request is based on a conflict between that requirement and my sincerely held religious beliefs, practices, or observances (hereafter called “religious beliefs”).

Are there any alternative accommodations that would eliminate the conflict of our requirement and your sincerely held beliefs?

  • No

 

  • Yes (if yes please explain):_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

Requester Signature___________________________________ Date: ____________

Accommodation Decision

  • Approved as requested
  • Approved but different from original request
  • Denied

Administrator Or Designee Signature: _____________