Do exempt customers require board approval?

No, unless your BSA Policy/Program should include that as a step.

I include my exemptions in my risk assessment by choice. That is reviewed annually by them.

Listing in risk assessment is reasonable. Having the board approve them is an upward delegation of responsibility.

How would a board member know whether to vote "Yes" or "No?"

Please don't give examiners any ideas here folks!

Thanks for the responses. We had not done this before, so I just wanted to get some feedback to make sure we weren't missing something.

Agreed, didn't say they "approve" the exemptions or the risk assessment, they only review the assessment so they're aware of our risks since they hold fiduciary responsibility. That's all.