Employee Return-to-Office Quarantine Clearance Form
Employee Name
Employee ID
Department
Position
Quarantine Start Date
Quarantine End Date
Reason for Quarantine
Symptoms Experienced (if any)
COVID-19 Test Performed?
Yes
No
Test Result
Negative
Positive
Not Applicable
Date of Last Test
Additional Remarks
Employee Signature
Date Submitted
HR Reviewed By
Review Date