Coronavirus (COVID-19): Self-Certification to Return to Work After COVID-19 Symptoms/Exposure Form
Author: XpertHR Editorial Team
When to Use
Due to the ongoing coronavirus (COVID-19) pandemic and the acknowledgement of community spread by the Centers for Disease Control and Prevention (CDC), an employer may wish to require that employees who have been ill with COVID-19 or have had close contact with an individual diagnosed or showing symptoms of COVID-19 to complete a self-certification form prior to returning to work. The form allows an employee to self-certify that they:
- Do not have symptoms of COVID-19;
- Have not had close contact with an individual diagnosed or showing symptoms of COVID-19; and
- Have not been directed to self-isolate or quarantine by their health care provider or a public health official.
An employer can use this form to provide to employees for self-certification before they return to the workplace.