COVID-19 RTW Review Request
Use this form to reduce or eliminate a recommended quarantine timeline.
Show
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Review Type
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Close Contact
Possible False Positive
Other (Note in timeline)
Symptomatic?
*
Yes, symptoms present
No, symptoms not present
Name of person being reviewed:
*
First Name
Last Name
Timeline:
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Include dates of all tests since exposure (include results), dates of notification, physician communications, and any other relevant information to justify the change requested.
Reason for Request to Review:
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Explain how the person's physical presence is critical to operations
Supporting attachments:
Browse Files
Drag and drop files here
Choose a file
Test results, doctor's notes, etc.
Cancel
of
Please note no one is cleared to return to work until approved by ViacomCBS senior leadership.
Contact Person:
First Name
Last Name
Email
example@example.com
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