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Travel Notification Form (COVID-19)
Please submit this form as soon as possible, but no later than one (1) week prior to travel.
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* Indicates required question
Today's Date
*
MM
/
DD
/
YYYY
Employee Name
*
Your answer
Department
*
Your answer
Supervisor
*
Your answer
Please complete the following:
I will be traveling (choose one)
*
In State
Out of State
Travel Destination (City and State):
*
Your answer
Purpose of Travel
*
Vacation
Non-Vacation
Dates of travel (indicate the day you plan to leave and plan to return):
*
Your answer
Employee Initials
*
Your answer
For use by Human Resource office only.
Employee IS required to quarantine upon return from travel due to travel destination being deemed a hot spot in regard to Coronavirus.
Yes
Employee is NOT required to quarantine upon return from travel due to travel destination not being deemed a hot spot in regard to Coronavirus.
Yes
Supervisor's Signature
Your answer
HR Manager Signature
Your answer
County Administrator's Signature
Your answer
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