COVID-19 Health Order FAQs about vaccination and testing

Get answers to questions about what the COVID-19 Health Order says about vaccination and testing.

NOTE: These FAQs are designed 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 most recent Health Order says.

Vaccination and testing FAQs for COVID-19 health orders

Who should get vaccinated and receive a booster?

It is a requirement for personnel in high-risk settings (like healthcare facilities and jails) to be up-to-date on vaccination. Proof of vaccination is required for anyone who routinely works in a high-risk setting. Employees who routinely work in a high risk-setting such as hospitals, skilled nursing facilities, residential care facilities for the elderly, homeless shelters and jails were required to be vaccinated with a complete initial series as of September 30, 2021 and "up-to-date on vaccination" (including receiving a booster if eligible) as of March 1, 2022 or within 15 days of when they become eligible to receive a booster.  Likewise, most other healthcare and in-home direct care workers, as discussed further below, were required, consistent with State orders and the local order, to be up-to-date on vaccination by March 1, 2022.

Workers in high-risk settings who were (1) vaccinated with a complete initial series and (2) recently infected with COVID-19 may, upon providing proof such as a lab result or doctor’s note, may defer getting boosted past the March 1, 2022 deadline for up to 90 days from the date of their first positive COVID-19 test or clinical diagnosis. Any worker with a deferral due to a proven COVID-19 infection must be up-to-date on vaccination no later than 15 days after the expiration of their deferral.

The October 13, 2021 full vaccination and the March 1, 2022 up-to-date on vaccination deadlines also apply to workers who are not permanently stationed in high-risk settings but who routinely enter hospitals or long-term care facilities as part of their duties, such as firefighters, paramedics, and emergency medical technicians (EMTs). All firefighters, paramedics, and EMTs now have until June 30, 2022, to be up-to-date on vaccination. The 90-day deferral for a post-vaccination, pre-booster infection also applies to these groups of workers.  Additionally, Personnel who routinely work onsite at homeless shelters (other than congregate living health facilities) are no longer required to receive a Booster but are strongly encouraged to do so. 

Personnel who are not permanently stationed or regularly assigned to High-Risk Settings but due to their duties may enter or work in High-Risk Settings on an intermittent or occasional basis or for short periods of time (such as police and lawyers who visit people in the jails) are no longer required to be up-to-date on vaccination, but are strongly encouraged to do so. 

What does it mean to be "up-to-date on vaccination"?

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. A person is considered up-to-date on vaccination two weeks after completing the full initial course of an approved vaccine until they are eligible for a booster. Once eligible for a booster, a person is considered up-to-date on vaccination immediately after receiving their booster. (For adults, this currently means receiving an additional dose of Pfizer, Moderna, or Johnson and Johnson five months after receiving a second dose of Moderna vaccine or Pfizer vaccine, or two months after receiving a single dose of Johnson and Johnson. For adolescents age 12 to 17, this means receiving a third dose of the Pfizer vaccine five months after receiving their second Pfizer dose. For anyone who received the full initial series of vaccination with a WHO-approved vaccine or with a mix of vaccines, see the guidelines linked later in the response to this question for details on booster timing.)

Consistent with CDC and State guidance, either the Pfizer-BioNTech (Comirnaty) or Moderna (Spikevax) COVID-19 vaccine is preferred for both the initial series and the booster.

The booster is especially important for people at risk for severe illness with COVID-19 and people who live or work with unvaccinated older adults and unvaccinated individuals with health risks. At this point, children five years old and older and all adults are eligible to be vaccinated, adults 18 years old and older can receive a booster of any type, and young adults 12-17 years old can receive a Pfizer booster.

The CDC has been frequently updating booster eligibility. More up-to-date information on booster eligibility may be found and individuals, Businesses, and government entities are urged to stay informed about changes.

Are any employees exempt from this vaccination requirement?

In many industries the health order strongly encourages, but does not require, employers to accept proof of a negative test or proof of vaccination for their employees. But in high-risk settings, all employees must still be up-to-date on vaccination (including receipt of a booster once eligible) unless they qualify for limited exemptions to vaccination requirements such as religious beliefs and qualifying medical reasons.

To claim an exemption, workers in high-risk settings must submit a declination form to their employer or the organization operating the high-risk setting. Unvaccinated exempt people who work in high-risk settings will be required to wear a well-fitted mask (except while actively eating or drinking). Use of non-vented N95 masks, supplied by the high-risk setting upon request, is strongly encouraged. Exempt employees must also get tested for COVID-19 at least once a week (and at least twice a week if the high-risk setting is a general acute care hospital, skilled nursing facility, intermediate care facility, or certain other locations) using either a nucleic acid or an antigen test.

Are employees who work in a covered high-risk setting prohibited from entering the high-risk setting for the two weeks after their final shot of the initial vaccine series until they meet the definition of "Up-to-date on vaccination," or can they mask and test in that interim two-week period? Are they still required to take special steps for a week after their booster?

As of March 1, 2022, employees in high-risk settings are required to be up-to-date on vaccination. This means two weeks must have passed since these employees completed an FDA authorized or approved COVID-19 vaccine regimen (either one dose of a single-dose regimen or the second dose of a two-dose regimen) and, once that the employee is eligible for a booster, immediately upon receiving an FDA authorized or approved COVID-19 booster shot. If an employee recently received their booster shot, they may immediately enter and work in the high-risk setting. If an employee recently completed their initial vaccine series, they may immediately enter and work in the high-risk setting if during the two weeks following their final vaccine dose of the initial series the employee:

  1. is tested for COVID-19 at least once a week (and at least twice a week if the high-risk setting is a general acute care hospital, skilled nursing facility, or intermediate care facility) using either a nucleic acid (including polymerase chain reaction (PCR)) or antigen test
  2. AND wears surgical mask or higher-level respirator approved by NIOSH (such as a N95) at all times in the high-risk setting in compliance with the State Public Health Officer Order of February 22, 2022.

So, for example, if an employee in a high-risk setting receives the final shot of the employee’s initial Pfizer-BioNTech vaccine series on September 29, 2021, that individual could continue to enter the facility to work through October 13, 2021 if that employee meets the masking and testing requirements. After October 13, that employee would be up-to-date on vaccination (until they are eligible for a booster) and would be subject only to masking and testing requirements applicable to all employees in the high-risk setting. Once that employee becomes eligible for a booster, they must receive the booster shot within 15 days of eligibility and will be up-to-date on vaccination immediately on receiving the booster. During that time (up to 15 days to get the booster), the employee can continue to enter the facility to work until the employee again meets the definition of up-to-date on vaccination if that employee follows the masking and testing requirements. An employer could still require additional safety measures, and any masking requirements that apply under state or local rules to fully vaccinated employees in such settings always apply.


I am an employee who works in a high-risk setting. 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?

The health order prohibits employees from working indoors at high-risk facilities unless they are vaccinated with a complete initial series (and are “up-to-date on vaccination” including receipt of a booster once eligible, as of March 1, 2022).  A worker may be able to obtain an exemption from the vaccination requirement, but only if they have a demonstrated disability or sincere religious belief that prevents them from receiving a COVID-19 vaccine and only if the employer can provide the employee with a reasonable accommodation. Nothing in the health order is intended to prevent an employer from engaging with its employees 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.

Last updated May 13, 2022