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?

On February 28th, 2023, the Health Officer terminated the local state of emergency and rescinded several health orders and directives. There are no current local health orders that apply to the general public, although there are recommendations for masking in healthcare settings.   

The Health Officer issued two new orders on February 28, 2023, including Health Officer Order No. 2023-01 Mandatory Masking of Personnel in Healthcare and Jail Settings that addresses masking for Personnel (i.e., employees,  workers, and volunteers) in healthcare and jail settings.   

Personnel who work in healthcare and jail settings, as described by the Mandatory Masking of Personnel in Healthcare and Jail Settings Order, are still required to wear a well-fitted mask when they are working in the same room as patients, clients, residents or people who are incarcerated. This requirement applies to all people who work in these settings (even if they are only there rarely), and regardless of their vaccination status. Masks are not required when no patients, clients, residents, or people who are incarcerated are present in the room.  

Beginning April 1, 2023, CDPH no longer mandates masks in high-risk settings. However, Personnel in such settings (and jails) in San Francisco will still be required to follow the local Mandatory Masking of Personnel in Healthcare and Jail Settings Order.  As noted above, that order does not require masking for patients or people who are incarcerated, only for Personnel who work in these settings when they are with patients, clients, residents, or people who are incarcerated. 

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. 

Who must get vaccinated and receive a booster?

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 Mandatory COVID-19 Vaccination of Healthcare Personnel Order.  Initially issued on February 28, 2023, and updated on June 22, 2023, Personnel who work regularly in healthcare facilities listed in Health Office Order No. 2023-02, must receive either an initial vaccine series and at least one booster dose or a single dose of the current bivalent formulation of the COVID-19 vaccine.  

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

Workers in Healthcare Facilities who were (1) vaccinated with a complete initial series of the monovalent vaccines only and (2) recently infected with COVID-19 may, upon providing proof such as a lab result or doctor’s note, defer getting a dose of the bivalent vaccine for up to 90 days from the date of their first positive COVID-19 test or clinical diagnosis. Any worker with such a deferral due to a proven COVID-19 infection must then receive their bivalent dose no later than 15 days after the expiration of their deferral.  For clarity, workers who have received a dose of the most recent bivalent formulation of the COVID-19 vaccine as part of their initial vaccination are not required to get additional doses at this time.  

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.  

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

According to the United States Centers for Disease Control and Prevention (CDC) definition for being up-to-date on vaccination, individuals aged 6 years and older are up-to-date when they have received at least one (1) dose of the most recent bivalent Pfizer-BioNTech or Moderna COVID-19 vaccine.  This dose may be as a booster or as part of an initial vaccination. The original two-dose ‘primary series’ is no longer available. 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. Learn more about up-to-date information on vaccine recommendations and eligibility. 

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. 

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 yet been vaccinated or boosted must receive a single dose of the most recent bivalent vaccine formulation within 15 days of starting work at the Healthcare Facility. For example, if a new employee has received the original initial series prior to starting employment, but has not yet received a bivalent dose, then the employee must receive their bivalent vaccine dose within 15 days of starting work.  If they have not received any vaccine doses, they must receive their bivalent vaccine dose within 15 days of starting work at the Healthcare Facility. New employees who have been vaccinated with an initial series and a booster that is not a bivalent dose, are recommended but not required to receive an additional bivalent vaccine dose.   

All Personnel who work in Healthcare Facilities, including those who have not received their complete initial series and a booster or a single dose of the bivalent vaccine, 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. 

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, as described in the Mandatory COVID-19 Vaccination of Healthcare Personnel Order, must require all workers who regularly work at healthcare facilities to have either 1)their initial vaccine series and at least one booster within 15 days of becoming booster-eligible or 2) at least 1 dose of the most recent bivalent formulation of the COVID-19 vaccine 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. 

How will the health orders be enforced?

Most San Franciscans have been doing an excellent job when it comes to protecting public health, and we have no reason to believe that will change. San Francisco's priority when it comes to public health orders has always been compliance rather than punishment, so the City's approach has been to first educate people about what the health orders require.  

There are no longer any health orders that have requirements for the general public.  If necessary, various City departments, including the Department of Public Health, the Sheriff, and Police, have the authority to issue notices of violation, orders to vacate the premises, or citations for violating health orders.