Employee Covid-Related Absence Notification
Employees of Mamaroneck UFSD are required to submit this information when absent due to suspected or confirmed reasons related to Covid-19. Information on this form is required by public health authorities.
Email address *
Employee Name *
Today's Date *
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Employee Date of Birth *
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Work Location *
Reason for Absence *
If you were exposed to a confirmed case of Covid-19, then please enter the date of exposure.
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DD
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YYYY
If you are covered under a quarantine order, please enter the dates of the quarantine.
Please include any other information relevant to your situation. The District will contact you to confirm next steps.
A copy of your responses will be emailed to the address you provided.
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