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Ex. SEC-12-077 Order Primary source read

Certification of Vaccination form (PRA version 7)

Certification of Vaccination (federal employees, onsite contractors and visitors)

Safer Federal Workforce Task Force / Office of Personnel Management (OMB Control No. 3206-0277) · United States (Federal)

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The COVID Project

The record

Jurisdiction
United States
Level
Federal
Authority
Executive Order 13991; 5 U.S.C. § 7301
Issued
2021-07-29 July 29, 2021
Effective
August 2021 (read as 2021-07-29)
End
Revised with EO 14043 implementation (post-period) (read as 2021-09-30)
In force
July 29, 2021 to Sept. 30, 2021
Quarters
2021 Q3
Limitation types
Face-covering requirementWorkplace rulesVaccination or testing
Addressees
  • federal employees
  • onsite contractors
  • visitors to Federal buildings
Functions reached
  • CS
  • DC
  • BD
Collection
Professional and Information Services SEC-12

Operative words

I understand that if I decline to respond or am not fully vaccinated, I must comply with [the following]: Wear a mask regardless of the level of community transmission... I am a visitor or I am an onsite contractor who is not enrolled in an agency's testing program... I sign this document under penalty of perjury

Enforcement

18 U.S.C. § 1001 (false statements); agency administrative action

Notes

The form itself states the rule imposed on onsite contractors and visitors

A record of The COVID Project. The instrument's text is the source's; the summary fields are The COVID Project's reading of it. Not legal advice.