Employee Authorization to Disclose COVID-19 Coronavirus Test Result
Understanding this form
The Employee Authorization to Disclose COVID-19 Coronavirus Test Result form allows employees who have tested positive for COVID-19 to authorize their employer to disclose their diagnosis to coworkers and others they may have encountered at the workplace. This form is essential for balancing the need for workplace safety with the privacy rights guaranteed by federal laws such as the Americans with Disabilities Act and the Family Medical Leave Act. Using this form is completely voluntary and should be based on the employee's comfort level with sharing their health information.
Key parts of this document
- Authorization statement for the employer to disclose the COVID-19 test result.
- Employee's acknowledgment of their rights under privacy laws.
- Section for the employee to provide their name and signature.
- Date of the employee's signature.
- A clear indication that signing the form is voluntary.
When to use this document
This form should be used when an employee tests positive for COVID-19 and wishes to inform their employer to facilitate communication about health and safety within the workplace. It serves to protect othersâ awareness of potential exposure while respecting the employee's right to privacy.
Intended users of this form
- Employees who have tested positive for COVID-19.
- Employers seeking a formal authorization to disclose COVID-19 diagnoses.
- HR departments responsible for managing workplace health and safety.
How to complete this form
- Identify the employer's name where indicated.
- Read and understand the privacy laws mentioned, specifically the Americans with Disabilities Act and Family and Medical Leave Act.
- Provide a clear authorization for the employer to disclose your COVID-19 positive result.
- Sign the form and include the date next to your signature.
- Print your name as required.
Notarization guidance
This form does not typically require notarization unless specified by local law. Ensure that all fields are completed accurately and signed to make it valid.
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Make edits, fill in missing information, and update formatting in US Legal Forms—just like you would in MS Word.
Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.
Sign and collect signatures with our SignNow integration. Send to multiple recipients, set reminders, and more. Go Premium to unlock E-Sign.
If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.
We protect your documents and personal data by following strict security and privacy standards.
Avoid these common issues
- Not understanding that signing is voluntary and should be done without pressure.
- Failing to provide all required information, such as name and date.
- Overlooking the need to comply with state-specific laws on medical information confidentiality.
Benefits of using this form online
- Convenient access to the form, allowing for easy completion at any time.
- Editable fields for customized entries, ensuring accurate details.
- Reliable access to legal forms, drafted by licensed attorneys to ensure compliance.
Legal use & context
- The form serves as a legal document for employees to authorize medical information disclosure.
- Failure to use this form could result in legal complications regarding privacy violations.
- The authorization is in compliance with federal privacy laws governing health information.
What to keep in mind
- This form allows employees to confirm their COVID-19 diagnosis disclosure to protect workplace safety.
- It is completely voluntary, and no adverse consequences will occur if not signed.
- Compliance with both federal and applicable state laws is crucial when using this form.
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FAQ
Topics should include signs and symptoms of infection, staying home when ill, social distancing, cloth face coverings, hand hygiene practices, and identifying and minimizing potential routes of transmission at work, at home, and in the community.
These people who have a positive test result should be considered infectious and remain isolated until they again meet criteria for discontinuation of isolation or of transmission-based precautions. Contact tracing during the person's second episode of symptoms is warranted.
Stay home. Most people with COVID-19 have mild illness and can recover at home without medical care. Do not leave your home, except to get medical care. Do not visit public areas.Take care of yourself. Get rest and stay hydrated. Take over-the-counter medicines, such as acetaminophen, to help you feel better.
Having antibodies to the virus that causes COVID-19 may provide protection from getting infected with the virus again. But even if it does, we do not know how much protection the antibodies may provide or how long this protection may last. Confirmed and suspected cases of reinfection have been reported, but remain rare.
There are two different types of tests diagnostic tests and antibody tests.
Cleaning staff should clean and disinfect offices, bathrooms, common areas, and shared electronic equipment used by the ill person, focusing especially on frequently touched surfaces. If other workers do not have access to these areas or items, wait 24 hours (or as long as possible) before cleaning and disinfecting. Employees who test positive for COVID-19 should immediately notify their employer of their results. Sick employees should follow CDC recommended steps to self-isolate or seek care. Employees should not return to work until they meet the criteria to discontinue home isolation, in consultation with healthcare providers.
Employees who test positive for COVID-19 should immediately notify their employer of their results.
Bringing exposed workers back should not be the first or most appropriate option to pursue in managing critical work tasks. Quarantine for 14 days is still the safest approach to limit the spread of COVID-19 and reduce the chance of an outbreak among the workforce.
People who receive positive results on an antibody test but don't have symptoms of COVID-19 or have not been around someone who may have COVID-19 are not likely to have a current infection. They can continue with normal activities, including work, but still take steps to protect themselves and others.
