Travel Compliance Form
In accordance with orders, visitors and residents arriving the state/city must complete the following. If you are arriving from a state with a high community spread rate, you must quarantine for 14 days unless you have a negative COVID-19 test result.
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Arrive Date
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please select the appropriate option
I did not arrive the state that has a high community spread rate.
I did arrive the state that does not have a high community spread rate.
Please select the appropriate option
I am quarantining for 14 days.
I will get a COVID-19 test, and quarantine until the negative test result received.
I was tested for COVID-19 before my arrival to the state.
Please select the appropriate option
The test result was negative.
The test result was positive and I remained in isolation.
The test result was positive and I will remain in isolation.
I will quarantine for 14 days until the negative test result received.
Signature
Date Signed
-
Month
-
Day
Year
Date
Print
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