LCHD Contact Quarantine Letter

Who can use this form? Members of the public who have been identified as close contacts and told they need to quarantine can use this form to generate a letter indicating the need to quarantine. Please note that this quarantine letter is not meant to be used by students attending daycare or K-12 schools, including summer schools.
What should students do? Students needing to quarantine should seek out a letter from the health department staff member who contacted them. If you are completing this form for a daycare-age or K-12 student who needs a letter and have NOT been contacted by the health department, please call the health department and ask to speak to a COVID-19 disease investigator.
No, this is not being completed for a student and do not to use this letter for daycare or school.Yes, I am completing this letter for a student or daycare aged child and need a letter for school/daycare-related activities
You may not complete this form. Please call the La Crosse County Health Department and ask for a COVID-19 Disease Investigator in order to get a quarantine letter.

Contact Quarantine Letter
Instructions: If you are a close contact to a positive COVID-19 case and need to present a letter to your employer regarding the need to quarantine, you may complete this form. Please note that all fields must be completed to access your letter.
As a reminder, this letter will NOT be accepted for students of K-12 schools or for daycare students. If you are needing a letter or guidance for a child who is daycare or K-12 school age, please contact the health department and ask for a Disease Investigator.
Your Name*
First NameLast Name
Please enter your date of birth.
MonthDayYear
Date
Date of Exposure
MonthDayYear
Date
What is the name of the individual to whom you were exposed? This information will be kept private and will not be shared with anyone outside of the health department. If you don't know, please enter "I don't know."*
Date of Exposure String
8-days post exposure
11-days post exposure
14-days post exposure
Your Email Address
example@example.com

Dear {yourName},
The La Crosse County Health Department is currently providing guidance to community members relating to risk associated with exposure to Coronavirus (COVID-19).
Health Department staff are diligently working to make sure that our community is safe from COVID-19. Currently, we are completing contact investigations on positive cases. Because you are receiving this letter, we have asked you to quarantine because you have been identified as a household or close contact of someone who is confirmed with COVID-19.
La Crosse County Health Department has received requests for documentation from employees who are being asked to self-quarantine in their homes due to risk from exposure to a positive COVID-19 case. Your 14-day quarantine period starts/started on {DateOfExposure} and goes through the end of the day on {14DaysPost}. A full 14 day quarantine is the best way to reduce risk of further spread in the workplace and community. If needed, however, and if all criteria listed below can be met, you may be able to shorten quarantine to 7 or 10 completed days.
A shortened quarantine is only possible if ALL of the following criteria can be met:
- you will be able to stay 6 feet away from others at all times
- you are able and willing to wear a properly fitting face mask at all times
- there is good ventilation in your work space and youc an avoid crowding/congregating of people
- you do not develop any symptoms
If you can meet these criteria, you may return to work:
- On {8DaysPost} after 7 days of completed quarantine, only if you get a negative test on day 6 or later, or
- On {11DaysPost} without a test if you have still developed no symptoms and can abide by all conditions described above.
If at any time you develop symptoms, you should immediately go home and isolate, and seek out testing.
We thank you for your cooperation with this quarantine. Let us know if you have questions about your COVID-19 exposure. To help employees, managers and supervisors, and your worksite maintain the best capacity in this emergency situation, we would suggest that you consult with your employer regarding any capacity they may have to faciliate remote work during your quarantine period.
For up-to-date information please visit our website www.lacrossecounty.org/covid19.

Gratefully,
La Crosse County Health Department

NOTE: This letter may NOT be used by students in daycare, K-12 schools or summer schools. Students needing a quarantine letter must get a different letter directly from their investigator.
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