Be Advised:

The purpose of this form is for an employee to file a complaint against their employer who implemented a COVID-19 vaccine requirement, alleging they failed to offer or provide an exemption from such requirement or otherwise violated Section 1 of House Bill (H.B.) 2001. To see the full text of H.B. 2001, click here.

This form is not an application for unemployment compensation benefits. To apply for unemployment benefits, go to and click on Login/Register. You will be navigated to the benefit login page. Click Login.

Brief Description of Section 1 of H.B. 2001:

During the Special Session of 2021, the Kansas Legislature passed H.B. 2001, which took effect on November 23, 2021. If an employer implements a COVID-19 vaccine requirement, Section 1 of H.B. 2001 requires the employer to exempt an employee from such requirement, without punitive action, if the employee submits a written waiver request to the employer stating the reason and complying with such requirement would:
  1. Endanger the life or health of the employee or an individual who resides with the employee, as evidenced by an accompanying written statement signed by a physician or another person who performs acts pursuant to practice agreements, protocols or at the order, direction or delegation of a physician; or
  2. Violate sincerely held religious beliefs of the employee, as evidenced by an accompanying written statement signed by the employee.

Punitive action means any of the following actions related to the employee's exemption request: Dismissal, demotion, transfer, reassignment, suspension, reprimand, warning of possible dismissal, withholding of work or assessing any monetary penalty or unreasonable charge.

An employee aggrieved by a violation of Section 1 of H.B. 2001 may file a complaint with Kansas Department of Labor (KDOL) alleging their employer failed to offer an exemption, improperly denied an exemption request, took punitive action against them, or committed any other violation of Section 1 of H.B. 2001.


To begin the process, you will answer some preliminary questions to determine whether Section 1 of H.B. 2001 permits you to file a complaint with the Kansas Department of Labor. If your answers to the questions indicate you may be able to file a complaint under H.B. 2001, you will be directed to the Multi-Factor Authentication (MFA) page to sign in or register for an account. To learn how to register for MFA click HERE.

Once you are signed in, you must complete the entire complaint form. If you exit the form before completing it, your answers will NOT be saved. Once you press submit, print the confirmation page for your records. Be advised that your answers to the questions are not confidential and any documentation you upload may be shared with the employer who you allege violated Section 1 of H.B. 2001 as part of KDOL’s investigation of your complaint.