Return to Work Self-Certification for COVID-19
Name: _____________________________________________ LOLA #: _____________
I have either tested positive for COVID-19, have had COVID-like symptoms, or have
been or believe that I have been exposed to someone who has tested positive or has
COVID-19 symptoms. I understand that I may return to campus only under the
following conditions and that I will comply with these guidelines.
• Persons with COVID-19 symptoms and/or a positive test who were directed to care for
themselves (self-isolate) at home may end self-isolation and return to campus when at
least three days (72 hours) have passed since recovery meaning:
o Fever free (temperature <100.4’F) without the use of fever-reducing
medications; AND
o Improvements in respiratory symptoms (e.g., cough, shortness of breath), AND
o At least 10 days have passed since symptoms first appeared.
• Persons with laboratory-confirmed COVID-19 who have not had any symptoms may
return to campus when at least 10 days have passed since the date of their last positive
COVID-19 test and have had no subsequent illness.
• Persons suspected of having COVID-19 who have been tested and receive a negative
test may return to campus provided they feel well.
• Persons who are sick with non-COVID-19 symptoms, or sick but tested negative for
COVID-19, must be symptom free for three days (72 hours) before returning to campus.
• Persons who have close contact (defined as within 6 feet for 15 minutes) of a person
with a confirmed positive test result may return to campus after a 14-day isolation
period has passed and no symptoms develop or after testing negative on the PCR test
conducted at least five (5) days after exposure to a COVID-positive person or a person
with a suspected illness.
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Signature Date
