Isolation Orders Request

Complete if you or your child has tested positive for COVID-19 and have been in isolation.

As per CDC guidance, since I or my child tested positive for COVID-19, I or my child must isolate for five (5) days from the onset of COVID-19 symptoms OR from the date of the positive COVID-19 test if asymptomatic. Day 1 of isolation begins the day after I or my child became symptomatic OR the day after I or my child tested positive if I or my child were asymptomatic. On day 6, if symptoms are resolving and there is no fever, isolation is complete. I or my child will continue to wear a mask for 5 additional days.

Your Name
Your Address
COVID-19 Test Information
Name of COVID-19 Positive Person

Sign above.

Note: Your signature does not have to be acknowledged by a notary public; you are swearing to the veracity of the information you have provided on the form.