{"id":"FED-278","kind":"order","level":"federal","jurisdiction":"United States (federal buildings)","state":"","metro":"","industry":"","agency":"","eco":"","issuer":"Safer Federal Workforce Task Force (OMB control number 3206-0277)","authority":"Executive Order 13991; the July 29, 2021 Model Safety Principles; 18 U.S.C. § 1001 (false statements)","instrument":"Certification of Vaccination form (employees, onsite contractors and visitors), August 2021","title":"Certification of Vaccination","dateIssued":"2021-08-06","effective":"August 2021","end":"2022 (superseded)","startDate":"2021-08-06","endDate":"2021-09-30","quarters":["2021Q3"],"types":["VAX","EMP"],"addressees":["federal employees","onsite contractors","visitors to federal buildings"],"clause":"I am a visitor or I am an onsite contractor who is not enrolled in an agency\u0027s testing program... [a] contractor making a false statement on this form could result in additional administrative action, including removal from a contract.","enforcement":"administrative action; removal from contract; 18 U.S.C. § 1001 warning","functions":["CS visitor and vendor entry to federal buildings","PL onsite contractors"],"notes":"The form every vendor, contractor and visitor to a federal building was asked to complete from August 2021.","sourceUrl":"https://www.saferfederalworkforce.gov/downloads/CertificationVaccinationPRAv7.pdf","snapshot":"https://web.archive.org/web/20210806200423/https://www.saferfederalworkforce.gov/downloads/CertificationVaccinationPRAv7.pdf","fileExists":true,"fileBytes":862191,"grade":"primary","character":"","description":"","collection":"FED-B","url":"/library/FED-278","exhibitUrl":"/exhibit/FED-278","citation":"Safer Federal Workforce Task Force (OMB control number 3206-0277), Certification of Vaccination form (employees, onsite contractors and visitors), August 2021 (Aug. 6, 2021) (Ex. FED-278)","stateName":"","related":["FED-272"]}