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COVID-19 Self-Reporting Form

Welcome

If you have tested positive for COVID-19 or have been exposed to someone who tested positive for COVID-19, use this form to self-report and request a return to work/school letter. 

Once you have completed this survey and our staff have received a copy of your laboratory results (if applicable), a Livingston County Health Department (LCHD) staff member will email you the letter requested within two business days. Questions about this form can be submitted to the LCHD: COVID19@livgov.com
 
Name: *This question is required.
This question requires a valid date format of MM/DD/YYYY.
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Home address: *This question is required.
This question requires a valid number format.
This question requires a valid email address.
Are you currently employed? *This question is required.
Which best describes your current place of employment? (Check all that apply) *This question is required.
Do you currently live in a congregate care or long term care facility?
Which statement best describes your current situation? *This question is required.