COVID-19 Isolation/Quarantine Forms

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New York State’s Approach to Isolation and Quarantine: What to Do If You Test Positive, Were Exposed to Someone Who Tested Positive or Display COVID-19 Symptoms

New York State Affirmation of Isolation Form

This form may be used as if it were an individual Isolation Order. Nassau County Department of Health or New York State Department of Health may contact you for additional information. This Attestation Form will contain your Isolation start and end date, as you indicate, based on your particular circumstances, in accordance with Guidance from the New York State Department of Health (see above link to New York State’s Approach to Isolation and Quarantine: What to do if you test positive, were exposed to someone who tested positive or display COVID-19 symptoms). 

This form may also be used for Isolation Release or for New York Paid Family Leave COVID-19 claims as if it were an individual Order for Isolation issued by New York State Department of Health or Nassau County Commissioner of Health.

New York State Affirmation of Quarantine Form

This form may be used as if it were an individual Quarantine Order. This Attestation Form will contain your Quarantine start and end date, as you indicate, and in accordance with Guidance from the New York State Department of Health (see above link to New York State’s Approach to Isolation and Quarantine: What to do if you test positive, were exposed to someone who tested positive or display COVID-19 symptoms). 

This form may be used for Quarantine Release, quarantine leave benefits, or for New York Paid Family Leave COVID-19 claims as if it were an Individual Order for Quarantine issued by the New York State Department of Health or Nassau County Commissioner of Health.