Title Page

  • Name

  • Department

  • Conducted on

  • File Number

Return to Work Details

Return to Work Criteria for HCP with Suspected or Confirmed COVID-19

  • Symptomatic HCP with suspected or confirmed COVID-19 (Either strategy is acceptable depending on local circumstances):

    Symptom-based strategy. Exclude from work until:
    - At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and,
    - At least 10 days have passed since symptoms first appeared

    Test-based strategy. Exclude from work until:
    -Resolution of fever without the use of fever-reducing medications and
    -Improvement in respiratory symptoms (e.g., cough, shortness of breath), and
    -Negative results of an FDA Emergency Use Authorized COVID-19 molecular assay for detection of SARS-CoV-2 RNA from at least two consecutive respiratory specimens collected ≥24 hours apart (total of two negative specimens)[1]. See Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens for 2019 Novel Coronavirus (2019-nCoV). Of note, there have been reports of prolonged detection of RNA without direct correlation to viral culture.


    HCP with laboratory-confirmed COVID-19 who have not had any symptoms (Either strategy is acceptable depending on local circumstances):

    Time-based strategy. Exclude from work until:
    -10 days have passed since the date of their first positive COVID-19 diagnostic test assuming they have not subsequently developed symptoms since their positive test. If they develop symptoms, then the symptom-based or test-based strategy should be used. Note, because symptoms cannot be used to gauge where these individuals are in the course of their illness, it is possible that the duration of viral shedding could be longer or shorter than 10 days after their first positive test.

    Test-based strategy. Exclude from work until:
    -Negative results of an FDA Emergency Use Authorized COVID-19 molecular assay for detection of SARS-CoV-2 RNA from at least two consecutive respiratory specimens collected ≥24 hours apart (total of two negative specimens).

    Note, because of the absence of symptoms, it is not possible to gauge where these individual are in the course of their illness. There have been reports of prolonged detection of RNA without direct correlation to viral culture.
    Note that detecting viral RNA via PCR does not necessarily mean that infectious virus is present.

    Consider consulting with local infectious disease experts when making decisions about discontinuing Transmission-Based Precautions for individuals who might remain infectious longer than 10 days (e.g., severely immunocompromised).

    If HCP had COVID-19 ruled out and have an alternate diagnosis (e.g., tested positive for influenza), criteria for return to work should be based on that diagnosis.

Employee Details

  • Job Title

  • Employee Number

  • Department

  • Contact Number

  • Name of HCP Supervisor

  • Date of meeting

Day/s of Absence (to be completed by your line manager with you)

  • First Date of Absence

  • Last Date of Absence

  • Date returned to Work

  • Total number of Working Days Absent

  • Reason for Absence (please specify the nature of your illness/symptoms)

Steps for the Involved HCP

  • Prepare sufficient supply (must last at least for 14 days after last exposure and until all symptoms are completely resolved or at baseline) of face mask to be worn at all times while in the healthcare facility

  • A facemask for source control does not replace the need to wear an N95 or higher-level respirator (or other recommended PPE) when indicated, including when caring for patients with suspected or confirmed COVID-19.

  • Avoid congregating in the break room or other crowded places

  • Ensure to self-monitor for symptoms, and seek re-evaluation from occupational health if respiratory symptoms recur or worsen

Steps for the Employer

  • Measure the employee’s temperature and assess symptoms prior to them starting work

  • Ensure sufficient supply of face masks to protect all HCP

  • Attempt to address social factors that might prevent HCP from reporting to work such as transportation or housing if HCP live with vulnerable individuals

  • Be aware of state-specific emergency waivers or changes to licensure requirements or renewals for select categories of HCP

  • Restrict HCP exposure from contact with severely immunocompromised patients (e.g., transplant, hematology-oncology)

  • Increase the frequency of cleaning commonly touched surfaces

  • Emphasize importance of proper hand hygiene

  • Install barriers to limit contact with patients at triage

Sign-Off

  • HCP Name and Signature

  • HCP Supervisor Name and Signature

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