Can you require drivers to get flu shots or other vaccines? Facility rules, exemptions, and accommodations

Federal law lets a private employer require drivers to get a flu shot or another vaccine, as long as it honors medical and religious exemptions. OSHA does not require employees to take flu vaccines, and its 2009 letter on mandatory flu shots says an employer may. The ADA and Title VII then require a company with 15 or more employees to consider exemptions, and some states add limits of their own. The rest of this guide covers what to do when a driver asks for an exemption, hospital and nursing home rules that reach your drivers, the state laws, and why hepatitis B is only offered. The bloodborne pathogens rules are in OSHA for NEMT, and cleaning and respiratory illness are in infection control for NEMT.

Can a ride company require drivers to get a flu shot?

Yes, if it handles exemptions. The EEOC’s pandemic guide, written in 2009 and revised in March 2020, asks whether an employer covered by the ADA and Title VII may compel every employee to take the flu or COVID-19 vaccine during a pandemic regardless of medical conditions or religious beliefs. Its answer is no, and it adds that ADA-covered employers should consider simply encouraging the flu vaccine rather than requiring it. Three rules sit behind that answer.

• The ADA, for medical reasons. A driver whose disability prevents vaccination may be entitled to an exemption as a reasonable accommodation, unless it would cause undue hardship, which the ADA defines as significant difficulty or expense. The EEOC’s technical assistance explains that an employer may apply a safety standard to everyone, but may not enforce it against someone whose disability prevents compliance unless that person poses a direct threat: a significant risk of substantial harm that reasonable accommodation cannot eliminate or reduce. The regulation requires an individualized assessment based on reasonable medical judgment (29 CFR 1630.2(r)).
• Title VII, for religion. Once the employer knows that a sincerely held religious belief prevents the vaccine, it must accommodate unless that would be an undue hardship. In Groff v. DeJoy, decided June 29, 2023, the Supreme Court held that the employer must show the accommodation would result in “substantial increased costs in relation to the conduct of its particular business.” The older “more than a de minimis cost” test is gone. EEOC pages written before 2023 still state it, and they now carry a notice saying Groff replaces it.
• OSHA’s whistleblower rule. OSHA’s 2009 letter on mandatory flu shots says an employee who refuses because of a reasonable belief that a medical condition creates a real danger of serious illness or death, such as a serious reaction to the vaccine, may be protected under Section 11(c) of the OSH Act.

Both laws count an employer from 15 employees, measured over 20 or more calendar weeks in the current or preceding year. A smaller company is outside both federal definitions, and its state’s anti-discrimination law may still apply. If the reason a driver cannot be vaccinated involves pregnancy, see accommodating pregnant drivers.

What do you do when a driver asks for an exemption?

Treat it as an accommodation request and decide it on that driver’s facts. The steps below follow the EEOC’s technical assistance, which is now an archived page last updated May 15, 2023, and the Groff test above.

1. Recognize the request. An employee with a disability does not have to mention the ADA or say “reasonable accommodation.” A religious request needs no magic words either, but the employee must explain the conflict and its religious basis.
2. Ask only what you need. For a religious request, assume it is sincere unless you have an objective basis to doubt it. If you do, a limited factual inquiry is allowed. Title VII does not protect objections based only on social, political, or economic views or personal preferences. For a medical request, the process may include asking for supporting medical documentation.
3. Look for an alternative that fits the runs you drive. The EEOC’s examples of accommodations for unvaccinated employees include a face mask, a modified shift, and reassignment. The VA’s flu directive, covered below, uses a face mask for exempt personnel throughout the flu season. Where a facility’s own rule is the reason for the mandate, one option is to keep the driver on runs that do not enter that facility.
4. Decide on the cost to your business, in writing. After Groff, the burden has to be substantial in the overall context of your business. A guess about hardship is not enough, and the EEOC says an employer cannot rely on speculative or hypothetical hardship.
5. Keep it private. The ADA makes it unlawful to disclose that an employee is receiving a reasonable accommodation or to retaliate against an employee for asking for one.

Can a hospital or nursing home require your drivers to be vaccinated?

Yes, through your contract with it rather than through a law that applies to your company. These examples show the range.

• Mass General Brigham. Its infection prevention standards for suppliers, updated June 15, 2025, require flu vaccination for supplier employees who work on site at any of its facilities or patient homes for one day or more during flu season, September 15 to April 30. The supplier keeps the documentation and provides it on request. Its further requirements for people on site more than three weeks are in becoming a hospital transportation vendor.
• The VA. VHA Directive 1192.01, dated August 10, 2020 and still posted in VA’s directive list, requires covered health care personnel to get a flu shot or an approved medical or religious exemption. Its definition of covered personnel includes VA contractors expected to work at its facilities. It tells contracting officers to make sure the requirement is expected in all contracts for on-site personnel. Exempt personnel complete VA Form 10-9050 and wear a face mask in any VHA location throughout the flu season, generally December 1 to March 31. The VA transportation contracts guide covers the contracts themselves.
• New York. Rule 2.59 of Title 10 is a mask-or-vaccinate rule for hospitals, nursing homes, diagnostic and treatment centers, home care agencies, and hospices. When the state health commissioner declares flu prevalent, a facility must make unvaccinated personnel wear a surgical or procedure mask in areas where patients or residents are typically present, and it supplies the masks free. The commissioner declared flu no longer prevalent on April 23, 2026, so the mask rule is off until the next declaration. Personnel includes contract staff, but the state health department’s FAQ, revised January 2, 2015, says contractors are covered only if they function as staff of the facility or are under its direct control. It lists ambulette and other transportation personnel under an ordinary contract as not covered. A facility may still adopt a stricter policy, so ask what yours requires.

Ask each facility for four things: the requirement in writing, the season dates, the proof it accepts and who holds it, and how an exempt driver is handled. Then schedule around the answer. The VA’s season and Mass General Brigham’s season are different, so a driver can be covered on one run and not on another.

Which states limit employer vaccine mandates?

Four states show how differently the limits work. These are examples, and other states have their own laws, some of them limited to COVID-19.

• Montana. Section 49-2-312 makes it an unlawful discriminatory practice for an employer to refuse employment, bar a person from employment, or discriminate in pay or terms and conditions based on vaccination status. Recommending a vaccine is allowed. A health care facility, as defined in section 50-5-101, has a limited exception, and the text does not name transportation companies. No one may be required to receive a vaccine allowed only under an emergency use authorization or one still in safety trials.
• Idaho. Idaho Code 73-503, as amended effective July 1, 2025, says a business shall not require a medical intervention as a term of employment unless federal law requires it, with a narrow exception for work in a foreign jurisdiction that requires one. The statute defines a medical intervention to include an injection or medication taken to prevent a disease. The same subsection exempts “business entities that receive medicare or medicaid funding.” A ride company paid for Medicaid trips may fit that exception, but the statute does not define “receive,” so get a legal answer before relying on it. Another subsection bars different pay, wages, or ongoing benefits based on whether an employee has had a medical intervention. The attorney general or a county prosecutor enforces it.
• Florida. Section 381.00316 bars a business from requiring documentation of COVID-19, emergency use authorization, or mRNA vaccination, or from discriminating based on that status, with fines up to $5,000 per violation. For vaccines outside that list, such as a conventional flu shot, the business must provide exemptions and reasonable accommodations for religious and medical reasons in accordance with federal law. The 2026 statute carries a note that it is repealed June 1, 2027.
• Texas. Health and Safety Code chapter 81D, added by Senate Bill 7 in 2023, bars private employers from requiring COVID-19 vaccination of an employee, contractor, or applicant, and from taking adverse action over a refusal. The Texas Workforce Commission can assess a $50,000 penalty per violation. It does not reach flu shots.

Does OSHA require drivers to take the hepatitis B vaccine?

No. OSHA requires the employer to make the vaccine available, not the driver to take it. Under 29 CFR 1910.1030(f), an employer must make the hepatitis B vaccine and series available, at no cost, to every employee with occupational exposure, within 10 working days of initial assignment and after bloodborne pathogens training. An employee who declines signs the statement in Appendix A and can change their mind later while still covered.

OSHA’s own answer on whether the vaccine can be a condition of employment is that it “does not have jurisdiction over this issue.” That leaves the ADA, Title VII, and state law to decide it, the same way they do for any other vaccine. OSHA also says an employer may not require a blood test before or after the vaccination. The OSHA guide for NEMT covers which drivers count as exposed, and the declination form holds OSHA’s wording.

Can you ask drivers for vaccination records?

Yes, and then you must protect them. The EEOC says requesting proof of vaccination is not a disability-related inquiry under the ADA, because many reasons besides a disability can explain why someone has no proof. The proof the employee hands over is medical information, and the ADA requires it to be kept confidential and separate from the personnel file.

The statute spells out the handling. Medical information goes on separate forms in separate medical files and is treated as a confidential record. Only three groups may be told: supervisors and managers about necessary restrictions on work or duties and necessary accommodations, first aid and safety personnel when emergency treatment might be needed, and government officials investigating compliance (42 U.S.C. 12112(d)). The EEOC’s example for a person who controls entry is that they receive a list of who may enter, not the medical reason. Dispatch can work the same way: a list of which drivers can take which runs, not who is vaccinated or why. The record retention guide covers where these files live, and the pre-employment physicals guide covers the same confidentiality rule for exam results.

Keeping vaccine details off the dispatch screen

A vaccination record is confidential medical information, so it does not belong on a driver’s dispatch profile. HealthRide’s driver records hold credentials with expiration dates, send reminders ahead of them, and warn dispatch before a driver with an expired one is assigned a trip, which suits dated facility requirements such as a site badge or an orientation sign-off. Vaccination proof and exemption paperwork stay in the separate medical file. Credentials are managed in fleet and credentials.