Can an employee withdraw an exclusion?

Yes. An employee can typically rescind an exclusion by submitting a new signed form indicating consent to biometric collection. Employers should log the rescission and update access-control configurations to reflect the new consent status.

Is a separate consent required for each biometric type?

Prefer separate entries for different biometric modalities. If an employee consents to one type but excludes another, the form should clearly identify each biometric category and the employee’s choice for each to avoid misapplication.

What if an employee provides limited medical information?

Record only what is necessary to evaluate accommodation needs. Avoid storing detailed medical records in the same personnel file; follow HIPAA guidance and consult legal counsel for health-related accommodations.

Do managers have authority to approve exclusions?

Approval authority should be defined in HR policy. Typically, HR or the privacy officer approves operational alternatives; managers should not unilaterally override formal exclusions.

How should disputes be escalated?

Escalate disputed cases to HR leadership and legal counsel. Maintain a written record of communications and final determinations, including dates, participants, and rationale.

Can exclusions affect security access?

Yes. Documented exclusions may require alternate authentication that still meets access-control policies. HR should coordinate with security teams to ensure alternatives do not weaken protections.

Electronic Signature
Templates
HR
HR Biometric Exclusion Form

HR Biometric Exclusion Form

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

HR BIOMETRIC EXCLUSION FORM

Employee Name: Employee ID:

Personal Information

Full Legal Name Home Address Primary Phone Email

Position Information

Job Title Department Reporting Manager Start Date Current Salary

Biometric Program and Exclusion Request

The Employer uses biometric identifiers and/or biometric information for identity verification and time and attendance purposes. By completing this form you are requesting to be excluded from biometric collection and use. Exclusion may be approved only when an appropriate alternative verification arrangement can be implemented without undue disruption.

Basis for Exclusion (check all that apply)

Religious belief or practice prevents participation.
Medical condition or disability documented by health provider.
Personal privacy objection asserted under company policy.
Other (describe below)

If Other or Additional Explanation, describe below Preferred Alternative Verification Method (choose one or more)

Personal Identification Number (PIN)
Proximity / Magnetic Badge
Manual time sheet / supervisor verification
Photo identification & manual check-in

Supporting Documentation Submitted

Employment History

Employer 1 - Company Name Employer 1 - Title Employer 1 - Dates Employed Employer 1 - Primary Responsibilities Employer 1 - Reason for Leaving Employer 2 - Company Name Employer 2 - Title Employer 2 - Dates Employed Employer 2 - Primary Responsibilities Employer 2 - Reason for Leaving

Education

Highest Degree Institution Graduation Date

References

Reference 1 - Name Reference 1 - Phone Reference 1 - Email Reference 2 - Name Reference 2 - Phone Reference 2 - Email Reference 3 - Name Reference 3 - Phone Reference 3 - Email

Legal Disclosures and Notices

At-Will Employment: Nothing in this form or any related accommodation shall alter the employment-at-will relationship unless reduced to a separate written agreement signed by an authorized company representative.

Equal Opportunity: The Employer complies with applicable equal employment opportunity laws. Exclusion requests will be considered without regard to legally protected characteristics, subject to legitimate business and safety requirements.

Biometric Data Privacy: If an exclusion request is denied or partially approved, biometric data collected shall be handled, stored, and deleted in accordance with applicable policy and law. Employees granted exclusion will not have their biometric identifiers enrolled for the specific systems identified in an approval notice.

Retention and Limited Use: Any biometric identifiers collected prior to a granted exclusion will be retained only as required by policy and will be destroyed or de-identified when permitted. The Employer will limit access to biometric data to authorized personnel for legitimate business purposes.

Applicant Certification and Authorization

I certify that the information provided on this form is true and complete to the best of my knowledge. I understand that making a materially false statement in order to obtain an exclusion may result in disciplinary action up to and including termination. I authorize the Employer to verify information provided herein and to contact the persons and organizations listed for purposes related to this request. I further authorize my medical provider to release supporting medical documentation if necessary to evaluate this request.

I understand that submission of this form is a request only and does not constitute approval. I agree to cooperate with any reasonable alternative verification method assigned if my request is approved.

Consent to Terms

I have read, understand, and agree to the statements in the Applicant Certification and Authorization section.

Acknowledgment of Authorization for Background or Employment Verification

By signing below I authorize the Employer and its agents to contact prior employers and references as necessary to verify employment history and to evaluate this exclusion request. I waive any claim against the Employer or its agents related to contacting those references for this purpose.

Employee Printed Name:

Employee Signature:

Date:

What the HR Biometric Exclusion Form Is and When It’s Used

The HR Biometric Exclusion Form documents an employee’s request to opt out of employer biometric data collection or to record an employer-approved alternative. It defines the biometric category involved (fingerprint, facial template, voiceprint, or other physiological identifiers), documents the employee’s choice, and records any agreed accommodation or alternative authentication method. Employers use it to support compliance efforts, log consent and refusal, and maintain a clear audit trail of requests and outcomes in personnel records.

Why a Clear Exclusion Form Matters for HR and Compliance

A formal exclusion form creates a verifiable record of employee decisions, reduces disputes about consent, and supports compliance with privacy and employment laws. It also clarifies operational steps and timelines for HR when biometric systems are in use.

Who Completes and Reviews This Form

Employers, HR representatives, and affected employees are the primary users of the HR Biometric Exclusion Form; legal or privacy teams may review high-risk cases.

HR administrator — records the request, confirms alternative authentication, and files the document in the employee record.
Employee — submits the exclusion request and indicates preferred alternative authentication or accommodation.
Privacy officer or counsel — reviews cases involving regulated health or financial data to confirm compliance.

Maintain copies in the personnel file and route any contested requests to legal or privacy staff for formal review.

Step-by-Step: How to Complete and Process an Exclusion Request

Follow these sequential steps to record, review, and act on an exclusion request.

01

Submit Request: Employee signs and dates the form.
02

HR Intake: HR logs the request and verifies identity.
03

Review Decision: Privacy or legal reviews high-risk cases.
04

Implement Alternative: Activate agreed alternative authentication.

Frequently Asked Questions About HR Biometric Exclusion Forms

Answers to common questions about completing, processing, and enforcing exclusion requests.

Need help? Contact support

Can an employee withdraw an exclusion?
Yes. An employee can typically rescind an exclusion by submitting a new signed form indicating consent to biometric collection. Employers should log the rescission and update access-control configurations to reflect the new consent status.
Is a separate consent required for each biometric type?
Prefer separate entries for different biometric modalities. If an employee consents to one type but excludes another, the form should clearly identify each biometric category and the employee’s choice for each to avoid misapplication.
What if an employee provides limited medical information?
Record only what is necessary to evaluate accommodation needs. Avoid storing detailed medical records in the same personnel file; follow HIPAA guidance and consult legal counsel for health-related accommodations.
Do managers have authority to approve exclusions?
Approval authority should be defined in HR policy. Typically, HR or the privacy officer approves operational alternatives; managers should not unilaterally override formal exclusions.
How should disputes be escalated?
Escalate disputed cases to HR leadership and legal counsel. Maintain a written record of communications and final determinations, including dates, participants, and rationale.
Can exclusions affect security access?
Yes. Documented exclusions may require alternate authentication that still meets access-control policies. HR should coordinate with security teams to ensure alternatives do not weaken protections.

Essential Elements Every Professional Exclusion Form Should Include

A robust form combines clear identification, precise choices, documented alternatives, and an audit trail for compliance and operational use.

Identification

Employee full name, ID number, department, and contact details to match payroll and access-control records precisely and avoid misattribution.

Biometric Specification

Clear selection of biometric modality(ies) being excluded so HR and security can target system configurations appropriately.

Reason and Accommodation

A concise reason field plus the alternative authentication method and any temporary or permanent status notes for operational clarity.

Authorization

Employee signature, printed name, and date, plus a space for HR or privacy official signature to confirm processing and outcome.

Processing Log

Internal section for intake date, reviewer name, decision code, and notes to create an audit trail for later review.

Retention Notice

Statement of how long the form will be retained and the legal basis for retention to inform employee expectations and compliance.

Security and Privacy Details to Record

Data Minimization: Capture only necessary fields

Access Controls: Limit access to HR and privacy staff

Audit Trail: Log timestamps and reviewers

Encryption: Store records encrypted at rest

Retention Policy: Follow retention timelines

BAA Requirement: Execute BAA if PHI involved

Common Legal and Operational Risks

Regulatory Violation: Fines and enforcement

Data Breach Liability: Exposure of biometric data

Discrimination Claims: Unequal application of exclusions

Operational Gaps: Access or authentication failures

Recordkeeping Failures: Missing audit evidence

Contractual Exposure: Vendor compliance gaps

Frequent Preparation and Processing Pitfalls

Failing to specify biometric modality precisely, which leads to partial or incorrect application of the exclusion and system misconfiguration.
Not documenting an alternative authentication method, leaving access-control gaps or forcing ad-hoc manager decisions that increase risk.
Storing sensitive medical explanations on the same form without segregation or access controls, increasing exposure under privacy laws.
Allowing supervisors to approve changes without HR or privacy oversight, producing inconsistent treatment and auditability problems.

How the Exclusion Request Flows Through HR and Security

A typical operational workflow moves from submission to verification, review, implementation, and archival with clear owner at each step.

Submission: Employee completes and signs form.
Verification: HR confirms identity and eligibility.
Review: Privacy or legal reviews complex cases.
Implementation: Security configures alternative authentication.

Typical Digital Workflow Settings for eSubmission

Configure your electronic workflow to capture identity, signatures, and an audit trail automatically.

Field	Configuration
Identity Verification	Email + optional SMS code
Signature Capture	Typed or drawn signature field
Conditional Fields	Show medical detail field only when needed
Retention Tag	Auto-apply retention policy metadata

Technical Considerations for Digital Forms and eSubmission

Ensure the platform supports secure storage, appropriate authentication, and an immutable audit trail before accepting electronic submissions.

Format Support: PDF and DOCX input
Authentication: Email, SMS, or stronger
Audit Trail: IP, timestamp, and actions

Confirm the platform can sign encrypted records, execute BAAs if handling protected health information, and integrate with HRIS and access-control systems.

Recommended Timelines and Expected Processing Windows

Set clear internal deadlines for intake, review, and implementation to ensure consistent handling and to reduce operational risk.

Acknowledgment Window:

Acknowledge receipt within 3 business days of submission.

Initial Review:

Complete initial HR review within 10 business days.

Privacy Review:

Escalated privacy/legal review resolved within 15–30 days.

Implementation:

Apply alternative authentication within 5 business days after approval.

Record Filing:

Store completed form in personnel file immediately after finalization.

Typical eSignature Provider Pricing and Feature Snapshot

Compare common plan-level criteria that affect implementation cost and compliance capability when selecting a provider for HR biometric exclusion workflows.

	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	Yes, 7-day trial	No	No	No	No
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Real-World Scenarios: How Organizations Use the Form

Two brief examples show how the form operates in practice and the outcomes it creates.

Hospital HR Process

A large hospital documents a clinician’s exclusion request for fingerprint scanning

Privacy team reviews under HIPAA considerations
HR implements badge+PIN alternative and logs the decision in the employee record with a 6-year retention tag.

Public Agency Case

A municipal transit agency records an operator’s religious-based exclusion for facial recognition

Legal confirms appropriate accommodation under workplace policy
Security configures proximity badge access and files the form as a public-employee record.

Typical Roles Involved in the Exclusion Lifecycle

HR Manager

HR managers intake requests, verify identity, record decisions, coordinate alternative authentication with security, and ensure forms are retained according to policy and legal requirements.

Employee Requestor

The employee completes the form, explains the exclusion reason concisely, selects or accepts an alternative authentication option, and signs to create a binding record for HR processing.

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