Health order FAQs

Note: These FAQs are to help answer your questions about the Health Order, but they are not updated as often. So, if there are any differences, follow what the current Health Order says.

Where is masking required?

The San Francisco Health Officer no longer requires masking in any setting, but anyone who wishes to have additional protection is encouraged to wear a well-fitted mask.  Effective April 30, 2024, at 11:59 p.m., the Health Officer rescinded Order No. 2023-01, which required personnel working in designated healthcare facilities to wear a well-fitted mask when interacting with patients, clients, or residents.

Health Officer Order No. 2023-01 required masking to protect patients during the designated winter respiratory virus period from November 1, 2023 to April 30, 2024.  Now that the winter respiratory virus period is over, covered healthcare facilities may now able to address respiratory viruses through their own infection control policies and practices. Those who operate such facilities can decide to implement their own requirements regarding masking for patients and staff. For instance, they may choose to continue the requirements of the prior order or may require masks in certain settings or circumstances (such as during an outbreak). Additionally, because it is not always apparent that a patient may be at higher risk, and to continue to encourage essential healthcare visits, SFDPH recommends that health systems and facilities implement policies that staff will mask on patient request, if their policy does not already require staff masking.

COVID-19 and other respiratory viruses continue to circulate, and we know that wearing well-fitted masks helps to decrease the transmission of all kinds of respiratory illnesses. In general, people should consider wearing a well-fitting, high-quality mask, such as a KF94, KN95 or N95, in crowded or poorly ventilated indoor settings, especially if they are at higher risk for severe disease or when the prevalence of respiratory diseases such as COVID-19 or influenza is high or increasing. In any setting, people can always choose to wear masks around others for added protection, and everyone should respect others’ choices around their health.

Is masking required on public transportation?

No. Masks are no longer required on public transportation. Individuals are encouraged to consider masking based on location, crowd, and personal risk factors, especially when an individual or the people they live with are vulnerable to the worst outcomes of COVID-19.  This includes on public transportation, while waiting for public transportation indoors, and when driving or riding in a taxi or rideshare vehicle.  

A transportation organization may decide to take additional steps to protect riders and personnel and require everyone to wear masks. Any additional requirements by a transportation organization should be followed. 

What are the requirements for COVID-19 vaccination for healthcare workers?

Effective April 1, 2023, the State rescinded its requirement for vaccination of healthcare workers. However, Personnel in healthcare facilities in San Francisco are still required to follow the Order of the Health Office No. 2023-02: Mandatory COVID-19 Vaccination of Healthcare Personnel. The Order was initially issued on February 28, 2023, and updated on June 22, 2023 and November 14, 2023. 

Personnel who work regularly in healthcare facilities listed in the Order must receive either 1) single dose of a vaccine available on or after September 1, 2022 authorized to prevent COVID-19, or 2) the full original monovalent course of vaccination plus any additional dose. Personnel who are already compliant with the vaccine requirement of this Order by receiving an original monovalent series plus any additional dose are recommended but not required to receive the most recent formulation once they are eligible.

Employers must maintain a program requiring vaccination and maintain records regarding vaccination or exemption status. This requirement applies to all people who routinely work onsite in these settings, but does not apply to people who only work at healthcare facilities on an intermittent or occasional basis or for short periods of time. 

The detailed requirements for vaccination are specified in the local order. 

Which “Healthcare Facilities” are covered by the Order? 

Healthcare Facilities are certain healthcare settings and facilities where vulnerable populations come into the facility, often out of necessity, and where some of those people have a higher risk of negative health outcomes due to COVID-19.  The included facilities are: (i) General Acute Care Hospitals; (ii) Skilled Nursing Facilities; (iii) Intermediate Care Facilities; (iv) Acute Psychiatric Hospitals; (v) Adult Day Health Care Centers; (vi) Program of All-Inclusive Care for the Elderly (PACE) and PACE Centers; (vii) Ambulatory Surgery Centers; (viii) Chemical Dependency Recovery Hospitals; (ix) Clinics & Doctor Offices (including behavioral health, surgical); (x) Congregate Living Health Facilities; (xi) Jail Health Facilities; (xii) Dialysis Centers; (xiii) Hospice Facilities; (xiv) Pediatric Day Health and Respite Care Facilities; and (xv) Residential Substance Use Treatment and Mental Health Treatment Facilities. 

What does “vaccinated with any additional dose” mean?

“Vaccinated with any additional dose” means having received any additional dose of a vaccine authorized to prevent COVID-19 by the FDA, including by way of an emergency use authorization, or by the World Health Organization (WHO), for which a person is or was eligible after that person was Vaccinated with an Original Monovalent Series. Consistent with CDC and CDPH guidance, either the Pfizer-BioNTech (Comirnaty) or Moderna (Spikevax) COVID-19 vaccine meets the requirements for being “vaccinated with any additional dose” after a person was vaccinated with an original monovalent series. This term includes any such additional dose authorized by the FDA or WHO, including formulations that are different than the original COVID-19 vaccines (such as an additional ‘booster’ dose of any of the original monovalent vaccine, a bivalent vaccine dose that became available in September 2022, the monovalent dose that became available in September 2023, or other future formulations). A person is considered “vaccinated with any additional dose” as soon as they receive any such additional dose.

What is the vaccination requirement for Personnel in healthcare facilities who have had COVID-19 infection?

Personnel who provide proof of recent COVID-19 infection as the basis for not being fully in compliance with the vaccination requirements listed in subsection (c) above may defer becoming “Vaccinated with any additional dose” for up to 90 days from the date of their first positive COVID-19 test or clinical diagnosis, which in some situations may extend the deadline for receipt of a vaccine dose. Personnel with a deferral due to a proven COVID-19 infection must be in compliance no later than 15 days after the expiration of their deferral.

What requirements remain for people who live and work in shelters?

As of March 1, 2023, the Health Officer no longer requires people who work in shelters to be vaccinated. However, it is still strongly recommended that Personnel in shelters stay up to date on their COVID-19 vaccinations given the strong protection vaccines offer against severe illness and death. Masking in shelters is no longer a City requirement, although individual shelter organizations may choose to continue to require masks for staff and clients. 

What is the difference between the required vaccine doses in Order 2023-02, versus being up-to-date on vaccination?

Personnel who are already compliant with the vaccine requirement of Order 2023-02 by receiving an original monovalent series plus any additional dose are recommended but not required to receive the most recent formulation once they are eligible.

The Centers for Disease Control and Prevention’s (CDC) definition for being up-to-date on vaccination varies by age and prior vaccination history. However, everyone age 6 months and older should get at least one dose of the updated 2023–2024 COVID-19 vaccines. Some people may need more doses. Visit the CDC to learn more.

Every eligible individual living, working, and visiting San Francisco is strongly urged to get up-to-date on vaccination as soon as they are able.

Which personnel in healthcare facilities are exempt from vaccination requirements?

The vaccination requirements apply to all Personnel who regularly work in Healthcare Facilities. But there are limited exemptions to vaccination requirements for religious beliefs and qualifying medical reasons. To claim an exemption, Personnel in Healthcare Facilities must submit a declination form to their employer or organization. An exemption from vaccination requirement does not extend to masking requirement – all Personnel who work in Healthcare Facilities are still required to wear a well-fitted mask when interacting with patients, clients, residents, or people who are incarcerated. Use of non-vented N95 masks is strongly encouraged. 

Workers who are not permanently stationed or regularly assigned to healthcare facilities but due to their duties may enter or work in these settings on an intermittent or occasional basis or for short periods of time (such as EMTs, paramedics, firefighters, police, other law enforcement, and lawyers who visit people in the jails) are no longer required to be vaccinated by the local Health Order, but are strongly encouraged to do so.

I am a new employee in a healthcare facility who is just getting up-to-date on my vaccination. When do I need to receive my vaccinations? 

Personnel who are new to working in a Healthcare Facility covered by Health Officer Order No. 2023-02 and have not met the vaccination requirements must receive a single dose of the most recent vaccine formulation within 15 days of starting work at the Healthcare Facility. 

I am an employee who works in a healthcare facility. Does the health order allow my employer to ask me for information concerning my request for an exemption based on a disability or sincere religious belief?

Yes. An employer must maintain records of personnel exemption status, consistent with applicable privacy laws and regulations, and may ask for information concerning a religious or medical exemption for the vaccine requirement. Employers may request additional information to determine whether the employee has a qualifying disability or religious belief or to determine whether the employer can offer the employee a reasonable accommodation. 

I operate a healthcare facility subject to a vaccination mandate under the health order. What do I do if an employee requests an accommodation for a sincerely held religious belief?

Operators of all healthcare facilities must require all workers who regularly work at healthcare facilities to meet the vaccination requirement in the Order unless those workers meet the requirements for a qualified medical or religious belief exemption. 

Operators are encouraged to consult with their own legal counsel before approving or denying an employee's request for an exemption from the vaccination requirement. Each request should be considered on a case-by-case basis, and the following is offered as general guidance only. Under the Health Order, an employee in these settings may be exempt from the COVID-19 vaccine requirement only under specific circumstances. In the case of a claimed religious exemption, the employee must establish that they have a sincere religious belief that prevents them from receiving the vaccine. If they make this showing, the employer must then engage with the employee to determine if the employer can provide a reasonable accommodation in lieu of vaccination. 

Additional guidance and resources for employers relating to requests for religious accommodation may be found on the California Civil Rights Department website by selecting the Employment FAQ at https://calcivilrights.ca.gov/covid-19-resources-and-guidance/.  

What if my employee claims they have a qualifying medical condition? What types of conditions qualify for an exemption from the vaccination requirement under the health order?

Under the Health Order, an employee may be exempt from the vaccination requirement if they have a qualifying medical condition. This means that they have a condition or disability recognized by the Federal Drug Administration ("FDA") or Centers for Disease Control and Prevention ("CDC") that prevents them from receiving a COVID-19 vaccination. 

A list of recognized conditions that prevent someone from receiving the COVID-19 vaccine is available, and includes: 

• Documented history of severe allergic reaction to one or more ingredients of all the COVID-19 vaccines available in the U.S.; or 
• Documented history of severe or immediate-type hypersensitivity allergic reaction to a COVID-19 vaccine, along with a reason why the individual cannot be vaccinated with one of the other available vaccines. 
• Conditions that do not prevent someone from receiving the COVID-19 vaccine (and which therefore do not qualify an individual for an exemption) include: 
• Allergic reactions (including severe allergic reactions) not related to vaccines (COVID-19 or other vaccines) or injectable therapies, such as allergic reactions related to food, pet, venom, or environmental allergies, or allergies to oral medications; 
• Latex, egg, or gelatin allergies; or 
• Delayed-onset local reaction around the injection site after the first COVID-19 vaccine dose. 

Additional guidance and resources for employers relating to requests for medical accommodation may be found on the California Civil Rights Department website by selecting the Employment FAQ at https://calcivilrights.ca.gov/covid-19-resources-and-guidance/.  

Are isolation and quarantine still required?

On February 28, 2023, the San Francisco Health Officer rescinded the Isolation and Quarantine Directive (2020-02). However, it is still strongly recommended that people stay home whenever they feel sick in order to protect others around them and follow the State’s isolation and quarantine guidance (see the guidance for isolation and what to do after close contact published by the California Department of Public Health).  

There are still legal requirements for employers to exclude people with COVID-19 from work according to the Cal OSHA COVID-19 Non-Emergency Regulations. In addition, there are specific requirements for healthcare personnel and skilled nursing facilities.