COVID-19 Attestation Form
Name:
Mobile/Home Phone Number:
Please select which one below applies to you and upload the completed form to MyInfo:
I have tested positive for COVID-19*.
I have Covid-19 symptoms, however, I have not tested positive for COVID-19.
I have come in contact with a household member that has been identified as a
close contact with a positive case.
I have come in close contact with someone, outside of my household, who
has COVID-19 or received a COVID-19 Alert notification.
By completing this form, I confirm that the information provided within this document is
accurate.
Signature:
Date:
*If you are sick beyond your self-isolation time of five days, you must complete
this attestation form and upload the completed form to myINFO to receive
additional quarantine days.
