Are electronic waivers legally binding?

Yes. Electronic signatures meet the ESIGN Act (15 U.S.C. ch. 96) and UETA in most states when intent, consent, attribution, and record retention are present.

Do waivers waive employer duties?

Not automatically. Courts may limit enforceability of broad releases; employers should avoid language that attempts to disclaim negligence or statutory duties.

Is a BAA required when collecting health data?

If the waiver collects protected health information handled by a covered entity or business associate, a HIPAA Business Associate Agreement is required to govern disclosure and safeguarding.

Can an employee refuse to sign?

Yes. Employers should have alternative policies; refusal may affect workplace access but actions must comply with labor and discrimination laws.

How long must waivers be kept?

Follow relevant standards: IRS records three years (IRC §6501(a)), HIPAA six years (45 CFR §164.530(j)), and I-9 retention rules per 8 CFR §274a.2.

Can the waiver be notarized or witnessed?

Not typically required, but some jurisdictions or employers prefer notarization for added authenticity; check state notary and witness rules before requiring notarization.

Electronic Signature
Templates
HR
Employee Covid Waiver

Employee Covid Waiver

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

EMPLOYEE COVID-19 WAIVER AND ACKNOWLEDGMENT

Personal Information

Full Legal Name Home Address

Phone:

Email:

Position Information

Position / Job Title Department Reporting Manager

Start Date:

Salary/Rate:

Employment History (Most Recent)

Employer 1 — Company Name

Title:

Dates Employed: From To

Primary Responsibilities Reason for Leaving

Employment History (Previous)

Employer 2 — Company Name

Title:

Dates Employed: From To

Primary Responsibilities Reason for Leaving

Education

Highest Degree or Certification Institution

Graduation Date:

References (Professional)

Reference 1 — Name

Phone:

Email:

Relationship:

Reference 2 — Name

Phone:

Email:

Relationship:

Reference 3 — Name

Phone:

Email:

Relationship:

Legal Disclosures

At-Will Employment: Employee acknowledges and agrees that, unless otherwise set forth in a written agreement signed by an authorized representative, employment is at-will. Either the Employee or the Employer may terminate the employment relationship at any time, with or without cause or notice.

Equal Employment Opportunity: Employer is an equal opportunity employer. Employment decisions are made without regard to protected characteristics, and Employee understands Employer's commitment to provide equal opportunity in all aspects of employment.

COVID-19 Acknowledgment, Assumption of Risk & Release

I acknowledge that COVID-19 is a contagious disease that can result in serious illness or death. I understand there is a risk of exposure to COVID-19 in the workplace despite Employer's reasonable precautions. By signing this Waiver I voluntarily assume all risk of illness, injury, or death related to COVID-19 that may result from my presence at work or participation in work-related activities.

I knowingly and voluntarily release, waive, and discharge Employer and its officers, directors, employees, agents, contractors, and affiliates from any and all claims, liabilities, demands, causes of action, or lawsuits arising from or in any way related to exposure to COVID-19, except for claims arising from Employer's gross negligence or willful misconduct.

Vaccination Status (select one):

Fully vaccinated
Partially vaccinated
Not vaccinated

If vaccinated, Vaccine Type:

Date of last vaccine dose:

I consent to Employer-administered or Employer-required COVID-19 testing, symptom screening, and temperature checks as a condition of my continued presence at work. I authorize the release of test results and related medical information to Employer for the limited purposes of workplace safety and contact tracing.

Consent (select all that apply) I consent to COVID-19 testing and screening I consent to release test results to Employer I have read Employer's vaccination/testing policy and will comply with job-related requirements

Health Reporting & Workplace Conduct

I agree to promptly report to Employer any positive COVID-19 diagnosis, known exposure, or onset of symptoms. I will follow Employer instructions regarding isolation, remote work, or return-to-work procedures. I understand failure to report or to follow applicable protocols may result in corrective action up to and including termination.

Release of Liability, Indemnity & Miscellaneous

Indemnity: To the fullest extent permitted by law, I agree to indemnify and hold harmless Employer for any claims, demands, liabilities, losses, costs, or expenses (including reasonable attorneys' fees) arising from my failure to follow public health guidance or Employer safety protocols, except for claims caused by Employer's gross negligence or willful misconduct.

Severability: If any provision of this Waiver is held invalid or unenforceable, the remaining provisions shall remain in full force and effect.

Governing Law: This Waiver shall be governed by the laws of the state where the Employee primarily performs work, without regard to conflict of laws principles.

Authorization & Certification

I authorize Employer to contact prior employers and references listed in this form, and to conduct background checks and verification of my employment history as required by Employer policy. I certify that all information I have provided in this form is true, complete, and correct to the best of my knowledge. I understand that falsification, omission, or misrepresentation of information may result in rejection of my application or termination of employment.

Applicant Certification

I have read this Waiver in full and voluntarily agree to its terms

Emergency Contact

Emergency Contact Name

Relationship:

Phone:

Employee Printed Name:

Signature:

Date:

What an Employee Covid Waiver Is and when it applies

An Employee Covid Waiver is a signed acknowledgement used by employers to document an employee's awareness of COVID-19 exposure risks, workplace protocols, and any agreement to follow safety measures. It commonly includes health attestations, consent to temperature checks or testing, and a limited release or assumption of risk language. Employers use the waiver to set expectations, record consent to workplace screening, and support internal health-and-safety procedures while preserving evidence that employees received required disclosures and instructions.

Why employers use an Employee Covid Waiver

A clear waiver helps document employee acknowledgements, supports consistent application of policies, and preserves contemporaneous records of health attestations and consent for screenings.

Who completes or receives this form

Common parties that complete or manage Employee Covid Waivers in the workplace.

Employees and new hires who will work on‑site; typically completed at hire or when returning to the workplace after remote work.
Human resources or occupational health teams who collect and retain signed attestations for compliance and case management.
Supervisors and safety officers who enforce mitigation measures and document that employees received safety disclosures.

Use this form alongside medical guidance, local public health directives, and any required privacy safeguards for health data.

Core sections to include in a professional Employee Covid Waiver

A complete waiver combines factual attestations, acknowledgements, limited releases, and guidance on testing, confidentiality, and data handling to ensure clarity and legal resilience.

Identification

Employee name, job title, employer name, and work location to connect the waiver to the proper employment record.

Health Attestation

A checklist or statement confirming the employee has no current COVID-19 symptoms, recent positive tests, or exposure as defined by public health guidance.

Testing and Screening

Consent to temperature checks, symptom screening, or testing procedures, and a statement on who covers testing costs if applicable.

Assumption of Risk

A clear statement that the employee understands residual risk despite employer precautions; avoid overly broad or all‑terms releases that conflict with state law.

Confidentiality

Procedures for protecting health information consistent with HIPAA where applicable and company privacy policies regarding disclosure.

Signature Block

Signature, printed name, job title, employer representative signature if required, and the date signed to evidence execution.

Data and compliance checklist for health-related records

Encryption: TLS 1.2/1.3 in transit; AES-256 at rest

HIPAA: Covered when PHI present; BAA required

Audit Trail: Timestamped signing events retained

Access Controls: Role-based permissions recommended

Retention: Follow legal and policy retention rules

Certifications: SOC 2 Type II, ISO 27001 available

Step-by-step: how to complete the Employee Covid Waiver

Follow these steps in order to complete and retain a valid waiver.

01

Gather employee details: Confirm full legal name, job title, and work site.
02

Complete health attestations: Answer symptom and exposure questions honestly and fully.
03

Consent and data handling: Confirm understanding of screening and privacy protections.
04

Sign and date: Sign, date, and return to HR; record retention begins on the effective date.

Configure a digital workflow for signing and storage

Key settings to set up before sending the waiver for signature.

Field	Configuration
Signature Field	Required, with date field adjacent
Authentication	Email link or SMS code for signer verification
Document Retention	Encrypted storage with access role controls
Audit Trail	Capture IP, timestamp, and action log

Typical eSigning flow for an Employee Covid Waiver

A standard online signing workflow reduces friction and preserves evidence of consent.

Upload document: HR uploads the waiver PDF or template.
Place fields: Add name, checkbox, signature, and date fields.
Send to signer: Issue an email or SMS signing link.
Capture audit trail: System saves timestamps, IP, and completion PDF.

Technical and platform requirements for secure eSubmission

Ensure your chosen eSignature platform supports required security, authentication, and record retention features before deployment.

Authentication: Email link, SMS code, or stronger 2FA
PHI Handling: HIPAA BAA availability if PHI present
File formats: PDF, DOCX, and audit-ready exports supported

Confirm integrations (HRIS, document management) and export options, and verify vendor compliance claims for HIPAA, ESIGN/UETA, and SOC 2 before storing health-related records.

Timing: when to collect and when records must be produced

Collect and retain waivers according to workplace policy and applicable legal retention rules; some actions require prompt collection.

Collection timing:

At hire, before site access, or on return-to-work.

Test results:

Provide within employer's notification timeline.

Reporting:

Report clusters per local public health timelines.

Access requests:

Respond to lawful access requests promptly.

Retention trigger:

Retention begins on the document effective date.

Common legal risks and potential penalties

HIPAA violations: Civil and criminal exposure

I-9 errors: Penalties $281–$2,789 per violation

Unenforceable release: Overbroad waivers may be void

Recordkeeping failures: State or federal fines possible

Discrimination claims: Improper exclusions can trigger suits

Tax withholding errors: Backup withholding triggers 24% rate

eSignature vendor comparison for signing and storing waivers

Platform capabilities and pricing vary. The table compares starting price, trial availability, bulk send, audit trail, HIPAA support, and typical envelope limits across common providers.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day trial	Varies	Varies	Varies	Varies
Bulk Send	Yes	Yes	Yes	Yes	Yes
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No cap	100 envelopes/user/yr	Varies	Varies	Varies

Real-world examples of how organizations use an Employee Covid Waiver

Two brief examples show common implementations across different employer types.

Healthcare clinic

A clinic requires a daily symptom attestation to enter clinical areas.

Staff complete an electronic form each shift.
The clinic retains audit-stamped PDFs for six years to align with HIPAA retention and to support any workplace exposure investigations.

Regional retailer

A retail chain uses a return-to-work waiver after an outbreak.

Employees sign once upon return and after close contacts.
The chain stores signed waivers centrally and couples them with temperature screening logs for local health-authority reporting.

Frequently asked questions about Employee Covid Waivers

Answers to common questions about enforceability, eSigning, privacy, and record retention for waivers.

Need help? Contact support

Are electronic waivers legally binding?
Yes. Electronic signatures meet the ESIGN Act (15 U.S.C. ch. 96) and UETA in most states when intent, consent, attribution, and record retention are present.
Do waivers waive employer duties?
Not automatically. Courts may limit enforceability of broad releases; employers should avoid language that attempts to disclaim negligence or statutory duties.
Is a BAA required when collecting health data?
If the waiver collects protected health information handled by a covered entity or business associate, a HIPAA Business Associate Agreement is required to govern disclosure and safeguarding.
Can an employee refuse to sign?
Yes. Employers should have alternative policies; refusal may affect workplace access but actions must comply with labor and discrimination laws.
How long must waivers be kept?
Follow relevant standards: IRS records three years (IRC §6501(a)), HIPAA six years (45 CFR §164.530(j)), and I-9 retention rules per 8 CFR §274a.2.
Can the waiver be notarized or witnessed?
Not typically required, but some jurisdictions or employers prefer notarization for added authenticity; check state notary and witness rules before requiring notarization.

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