Isolation Order/Affirmation of Isolation Form
If you or your child or dependent has tested positive for COVID-19 and have been in isolation, your employer/school may require the New York State Department of Health AFFIRMATION OF ISOLATION. This self-reporting form serves as your Order of Isolation and can be submitted for New York Paid Family Leave COVID-19 claims. After completing the form, please remember to save a copy for your records. This form is for your own use, please do not submit to the Monroe County Department of Public Health.
NYS Affirmation of Isolation Form
Quarantine Order/Affirmation of Quarantine Form
If you or your child or dependent has been exposed to an individual infected with COVID-19 and have been in quarantine, your employer/school may require the New York State Department of Health AFFIRMATION OF QUARANTINE. This self-reporting form serves as your Quarantine Order and can be submitted for New York Paid Family Leave COVID-19 claims. After completing the form, please remember to save a copy for your records. This form is for your own use, please do not submit to the Monroe County Department of Public Health.
NYS Affirmation of Quarantine Form
