COVID-19 Close Contact Affidavit (Staff Only)

Name*

First NameLast Name

Email*

example@example.com

I declare the following:*

I have been notified that a preliminary investigation of contact tracing revealed that I may have been a possible close contact as defined by the Centers for Disease Control and Prevention (CDC).I understand that the term possible is used because The Pro-Vision Academy (PVA) cannot guarantee that the exposure met both criteria (within 6 feet for a cumulative total of 15 minutes or more). However, because PVA believes that I met at least one (cumulative total of 15 minutes or more), they are being cautious and notifying me accordingly.I understand that per the Texas Education Agency (TEA) for staff who meet the close contact threshold with a COVID-19 positive individual and are in one of the following groups, do not need to stay at home. GROUP ONE: Ages 18 or older and have received all recommended vaccine doses, including boosters and additional primary shots for some immunocompromised people. GROUP TWO: Was confirmed COVID-19 positive within the last 90 days and has fully recovered. Furthermore, I declare that I will adhere to this requirement set forth by the TEA for public school staff.I understand that per the TEA for staff who meet the close contact threshold with a COVID-19 positive individual who are not in one of the above groups, it is recommended that the school system require that staff remain off campus during the stay-at-home period. If these staff continue to work on campus, rapid testing must be performed periodically for 5 days post-exposure, with testing on the 5th day recommended. Furthermore, I declare that I will adhere to this requirement set forth by the TEA for public school staff.I understand that if I continue to report following a close contact notification, that a rapid test must be performed within 24 hours of close contact notification, and again 3-5 days after first rapid test. This is a minimum requirement of PVA staff identified as close contacts. Furthermore, I declare that I will adhere to this requirement.I declare that I will wear a mask for the next 14 days, monitor myself for symptoms, and adhere to the recommended CDC guidance for close contact individuals while on campus.Lastly, I declare that if I become ill, exhibit COVID-19 symptoms and/or test positive for COVID-19, I will notify the Chief HR Officer and my supervisor immediately, AND I will not report to campus. Furthermore, I declare that I will complete the COVID-19 Case Reporting Form if I test positive for COVID-19.

Signature*

Date*

Date