Return to Work

Your Department*

Name*

First Last

Email*

Have you had any of the symptoms below in the past 24 hours?*

Any one of the following not explained by a known medical or physical condition:

OR
At least two of the following not explained by a known medical or physical condition:

You should isolate at home for a minimum of 7 days since symptoms first appeared.
You must also have 3 days without fevers and improvement in respiratory symptoms.

Have you had any close contact in the last 14 days with someone with a diagnosed case of Covid-19?*

Anti-SPAM Code

CHOOSE A DEPARTMENT ABOVE SO YOU CAN SUBMIT THIS FORM.

Email

This field is for validation purposes and should be left unchanged.