Return to Work Attestation Following Being COVID-19 Positive

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The Suffolk County Department of Health and the North Babylon School District have recently changed their protocols to return to work after testing positive for COVID-19. The District can now allow all employees to return to work after 5 days of their isolation period 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 day 0 is (the day my symptoms started or the date of my test if asymptomatic) *

YYYY

I meet the following criteria to return to work after day 5 of my COVID Isolation (You must check all to qualify) *

I have no symptoms or my symptoms are resolving

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 am not moderately or severely immunocompromised

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 chnages

Other:

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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