Quarantine Attestation Form

This form serves as a formal attestation that I have met the below criteria to safely return to work following exposure to COVID-19. I affirm the below to be true and will continue to comply with MSK’s COVID-19 policies and practices, including but not limited to PPE adherence, social distancing and daily completion of the HealthCheck Tool, upon my return to work.

This completed form, having been electronically signed, will serve as my “Fit for Full Duty” disposition, authorized by Employee Health and Wellness Service, to return to work onsite at an MSK facility.