Return to Work Attestation Following Quarantine After Being Deemed a Close Contact of a Person Positive for COVID-19

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The Suffolk County Department of Health and the North Babylon School District have recently changed their protocols regarding exposure to someone who has contacted COVID-19 and has been deemed a "close contact." The District can now allow all employees to return to work earlier should the employee meet all of the criteria in the form below.

Email *

Last Name *

First Name *

What is your position in the District? *

Administrator

Teacher (Includes Guidance Counselors, Social Workers, and Psychologists, Speech Pathologists, ENL Teachers, AIS Teachers, Reading Teachers))

Paraprofessional/Cafeteria Aides

Office Personnel (all titles including Door Monitors)

Nurse

Custodian (Includes Chiefs, Heads, and part time employees)

Bus Driver

Bus Matron

Mechanic

Coach (Non North Babylon Teacher)

Food Service Workers (Cooks, Assistant Cooks, Food Service Workers)

Technology Department (Custom Computer Employees, Network and Systems Specialist II)

Substitute Teachers (Including Permanent and Per Diem Substitutes)

Student Teacher/Observer

Grounds Worker

Security

Required

What is your home school/location? *

District Office

North Babylon High School (Includes Directors, Technology Department)

Robert Moses Middle School

Marion G. Vedder Elementary School

William E. DeLuca Elementary School

Belmont Elementary School

Woods Road Elementary School

Parliament Place Elementary School

Transportation Office

Districtwide (Grounds Crew, Maintenance Mechanics, etc)

Required

My date of exposure: *

YYYY

I am not required to quarantine as

I am fully vaccinated (2 Pfizer/Moderna Shots or 1 Johnson and Johnson shot)

I have had COVID-19 within the past 90 days

I am unvaccinated and have completed my 5 day quarantine

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I meet the following criteria to return to work (all must be checked to qualify) *

I have no symptoms

I have not had a fever with in the the last 24 hours and have not used fever reducing medication.

I am able to wear a well fitting mask correctly

I will practice social distancing at work at all times

I will continue to monitor for symptoms and if anything changes and will alert administration if anything changes

I am aware it is recommended to have a test after day 5

Required

I can be contacted at: *

I hereby certify the above information is true and will be returning to work on *

YYYY

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