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COVID-19 Request for Reinstatement

This form must be completed by employees that requesting to return to work after being absent for COVID-19 reasons. Required fields marked with an asterisk *

DO NOT RETURN TO WORK UNTIL YOU RECEIVE APPROVAL VIA EMAIL FROM THE HUMAN RESOURCES OR BENEFITS SUPERVISORS.

Contact Information

First Name*

Answer Required

Middle Initial*

Answer Required

Last Name*

Answer Required

Employee ID #*

Answer Required

Position*

Answer Required

Date Tested Positive

Answer Required

Last Day at Work*

Answer Required

Check all that apply. *

Answer Required

Completed quarantine period, no symptoms

10 days since positive test, not experiencing symptoms

24 hours symptom-free without fever medication

Bartlett City Schools will keep all medical information confidential and will only disclose it on a need-to-know basis. This notification may lead to others concluding that you have the virus due to your absence from work. Please know that your privacy is a priority, however we must also make provisions to provide for the safety of all employees and students within the district. Contact Gina Bennett, Human Resources Supervisor, ([email protected]) with concerns.

For more information on COVID-19, including symptoms and treatment, visit the CDC website at www.cdc.gov (https://www.cdc.gov/).

Confirmation Email

Confirmation Email *

Email Required