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On February 28th, 2023, the Health Officer terminated the local state of emergency and rescinded several health orders and directives.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 and workers) 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. 

Until April 1, 2023, State guidance continues to require masking in healthcare facilities by both Personnel and patients. On and after April 1st, CDPH will no longer mandate 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?

The Health Officer issued a new order on February 28, 2023, Health Officer Order No. 2023-02, regarding vaccination requirements for personnel in healthcare facilities.  That order continues to mandate an initial vaccine series and at least one booster dose for Personnel who work regularly in healthcare facilities listed in the Mandatory COVID-19 Vaccination of Healthcare Personnel Order.  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. 

Of note, effective April 1, 2023, the State requirement for vaccination of healthcare workers will be rescinded. However, Personnel in healthcare facilities in San Francisco will still be required to follow the Mandatory COVID-19 Vaccination of Healthcare Personnel Order.  

The detailed requirements for vaccination and a booster dose are specified in the local order.

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 and (2) recently infected with COVID-19 may, upon providing proof such as a lab result or doctor’s note, defer getting boosted 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 have received their first booster no later than 15 days after the expiration of their deferral.

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 and boosted 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, people who work in shelters are no longer required to be vaccinated and boosted. 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"?

The United States Centers for Disease Control and Prevention (CDC) updated its definition for being up-to-date on vaccination as follows: “You are up to date with your COVID-19 vaccines if you have completed a COVID-19 vaccine primary series and received the most recent booster dose recommended for you by CDC.” You are also up to date if you have received your primary series, but are not yet eligible for a booster dose.” 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 booster 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, workers 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 are not yet vaccinated and boosted must begin the process of receiving their complete initial series and at least one booster within 15 days of starting work at the healthcare facility. For example, if a new employee has received the initial series prior to starting employment, is booster eligible, but has not yet received a booster, then the employee must receive their booster dose within 15 days of starting work.  If they have not received any vaccine doses, they must receive their first dose in the initial series within 15 days of starting work at the healthcare facility and then must continue to complete the initial series and receive a booster once eligible. 

All Personnel who work in healthcare facilities, including those who have not received their complete initial series and a booster, 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? What qualifies as 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 their initial vaccine series and at least one booster within 15 days of becoming booster-eligible (i.e., meets the booster criteria recommended by the CDC) 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.

To qualify for a religious exemption from the health order's vaccination requirement, an employee must demonstrate:

1. the employee has a sincerely held belief that prohibits them from receiving the vaccination, and
2. that belief is religious rather than secular or scientific.

Employees may make a request for exemption verbally or in writing. And an employer may request its employee supply additional written information about the claimed belief. 

As to the first step of this test, generally, an employer should assume that an employee seeking a religious exemption does so in good faith, unless there is an objective basis for questioning their sincerity. For example, if it’s known that the employee only recently adopted the stated belief and the employee recently received other vaccinations, this information may be an objective basis for requesting more information about the nature of their seriously held belief. 

As to the second step of the test, the fact that an employee claims that their belief is religious is not determinative. When an employee makes a claim for religious exemption, the employer may attempt to determine whether the belief is, in fact, religious or secular in nature. An employee's political, sociological, personal, or philosophical views do not qualify as religious beliefs that would support an exemption under applicable state or federal law.

The ultimate inquiry is whether the employee has a belief that occupies a place in their life parallel to that filled by God in traditional religions. If an employee's request for an accommodation does not readily demonstrate that their belief is sincere or religious in nature, the employer may make further inquiries, such as:

• request additional information about the employee's belief system, the nature and tenets of their asserted beliefs, and how they follow the practice or belief;
• review written religious materials describing the belief or practice; and
• obtain a supporting statement from a religious leader or another member of their community who is familiar with the employee's belief system.

The following is a non-exhaustive list of beliefs state and federal courts have held are not religious (and therefore, standing alone, do not warrant an exemption):

• fear of possible side effects from immunization;
• a desire to live a "healthy" or "pure" lifestyle;
• opposition to vaccination due to veganism;
• a belief that the vaccine will do more harm than good; and
• distrust in the government or the science supporting vaccination.

Most organized religions do not prohibit vaccinations. A non-exhaustive list of religious faiths and their stance on vaccination is available. But an employee is not required to cite a recognized religion or religious tenet to qualify for an accommodation. As to the COVID-19 vaccine specifically, neither the Pfizer nor Moderna vaccines contain fetal cells. An employee's concerns about the use of fetal cell lines in researching the COVID-19 vaccines may also not qualify as a sincere religious belief since those same cell lines were used to develop many other vaccines, including those for hepatitis A, rubella, and rabies. If the employee has previously received other vaccines without concern, the claimed belief may not be sincere or religious.

If an employee does have a sincere religious belief that prevents them from receiving the COVID-19 vaccine, the employer must then determine whether it can offer a reasonable accommodation. Employers are not required to accommodate employees if it would cause an undue burden on operations or result in more than a "de minimis" cost to the business. For example, an employer does not have to accommodate an employee's religious beliefs if the accommodation is costly, infringes on other employees' job rights or benefits, compromises workplace safety, decreases workplace efficiency, or requires other employees to do more than their share of potentially hazardous or burdensome work.

In making this determination, an employer may consider whether the employee's job requires them to encounter non-employees whose vaccination status could be unknown or who may be ineligible for the COVID-19 vaccine. In such cases, an unvaccinated employee may pose a direct threat of harm to coworkers or non-employees if they remain in the workplace and an accommodation may not be possible.

Whether an employer can offer an accommodation depends on the nature of the business and the specific employee's job duties. An employer must engage in an interactive process with its employee to determine whether a reasonable accommodation exists under the particular circumstances. Depending on the employee's job duties and location, reasonable accommodations may include requiring the employee to regularly test for COVID-19 and wear an appropriate face covering, allowing the employee to telework, or transferring the employee to a different position or location.

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.

If an employee believes they have a qualifying condition, they must provide their employer (or the business where they are working) with a signed statement from a physician, nurse practitioner, or other licensed medical professional practicing under the license of a physician stating that the individual qualifies for the exemption. The statement should not reveal any underlying medical condition or disability. The California Medical Board has announced that licensees who grant an exemption without a legitimate medical reason may be subject to disciplinary action.

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.