Vaccine Reporting and Exemption Forms (Faculty & Staff)


Although the campus-wide deadline to submit proof of vaccination is August 2, we are asking all employees to report their vaccine status by June 15.

Dear Faculty and Staff,

Yesterday, President Elam sent an email regarding Oxy’s new COVID-19 vaccination requirements, along with information about our updated testing protocols for vaccinated and unvaccinated community members.

In line with this new policy, all employees must submit proof of vaccination or request an exemption. Although the campus-wide deadline to submit proof of vaccination is August 2, we are asking all employees to report their vaccine status by June 15 so that we can understand what percent of Oxy students, staff and faculty are vaccinated.

Process for Reporting Your Vaccine Status

  • If you have already been vaccinated and have uploaded your proof of vaccination through the MyHealth portal, no further action is required. You will receive a status confirmation from Emmons by June 15. 

  • If you have been vaccinated and have not uploaded your proof of vaccination through the MyHealth portal, you must submit proof of vaccination following the instructions below.  

  • If you have not yet been vaccinated and intend to be fully vaccinated by August 2, please complete the form titled “COVID-19 Intent to Vaccinate” and upload it to the MyHealth portal. Please note that you will need to go back into the portal by August 2 to submit proof of vaccination. If you intend to submit a medical, religious, or personal exemption, those forms are attached to this email. Please note that while personal exemptions are being accepted at this time, they will be revoked upon full FDA approval of any of the COVID-19 vaccines, and you will need to update your vaccination status. Unvaccinated individuals with an approved exemption will be subject to twice-weekly testing, as well as other preventative measures (including but not limited to masking, daily health checks, social distancing, etc.) to protect the health and well-being of the Oxy community. 

To submit proof of vaccination or an exemption form, please do the following:

  • Log into myhealth.oxy.edu using your Oxy credentials
  • Complete the 2-step verification
  • On the front page, choose: Enter My COVID-19 Vaccine Information
  • Upload a picture of your vaccination card OR exemption/declination/intention form
  • If vaccinated, enter the date vaccinated and type of vaccine received
  • Click “Done.” All fields may be updated at any time and new files can be uploaded to replace existing ones
  • You will receive a status confirmation from Emmons within two weeks

Vaccine Reporting Forms

Intent to Vaccinate        Medical Exemption        Religious Exemption        Personal Declination   

Thank you so much for your time and attention. This is an exciting and important step as we plan for an in-person return to campus this fall!

Be well,
Sara Semal