Staff Absence Request

Staff Absence Request/COVID Reporting

Submitting this Form for:*

If the staff member or anyone in their household has traveled to any state that is currently on the list of states that NJ has quarantining requirements for, please report in the BOX ABOVE: 1. WHO in the household, 2. STATE, 3. DATE of travel and Length of time spent there, and 4. PRECAUTIONS taken in the household to quarantine. The Nurse will contact you for further info. and with next steps.

If you believe you or anyone in your household has possibly been exposed to COVID-19, or if someone in your household has tested positive, reporting this is required here. Please report in the BOX ABOVE: 1. WHO in the household was possibly exposed or tested positive, 2. DATE of possible exposure or positive test, and 3. HOW possibly exposed. The Nurse will contact you for further info. and with next steps.