Employee Name (required)
If an employee’s body temperature is at or above 100.4 degrees Fahrenheit, the employee must be sent home immediately.
Date employee was sent home (mm/dd/yyyy)
Have COVID-19 symptoms in the past 14 days
Have a positive COVID-19 test in the past 14 days
Have close contact with a confirmed or suspected COVID-19 case in the past 14 days
Have travel from within one of the designated states with significant community spread?
If the employee answered yes to any of the questions above, the employee must be sent home.
Are visible signs of respiratory illness present?
If you are sick or have one or more of the above symptoms:
• You must stay home or leave the JHS facility at which you are working.
• Follow the agency procedure for calling out sick
• Contact your health care provider for medical guidance.
Close contact includes being within approximately 6 feet of a person with confirmed COVID-19 for more than a few minutes, living with a person who has COVID-19 or having direct contact with infectious secretions of a COVID-19 case (e.g., being coughed on, kissing, sharing utensils).
The employee may return to work earlier if a doctor confirms the cause of the employee’s fever or other symptoms is not COVID-19 and provides a written release for the employee to return to work.
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