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WHOA, DISLOCATED WORKER (DW) COVID-19 SELFATTESTATION FORM IDENTIFYING INFORMATION Applicants NameAddressCalJOBS User ID#DISLOCATED WORKER CATEGORY DW Category 1Terminated/Laid Off DW Category 5SelfEmployed

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How to fill out coronavirus self-attestation form

01

Step 1: Obtain the coronavirus self-attestation form from a reliable source such as the official government website or healthcare provider.

02

Step 2: Read the instructions provided on the form carefully to understand the required information.

03

Step 3: Fill in your personal details accurately, including your full name, date of birth, and contact information.

04

Step 4: Answer the questions about your recent travel history accurately, including any international travel or visits to high-risk areas.

05

Step 5: Provide details about any symptoms you may be experiencing, such as fever, cough, or shortness of breath.

06

Step 6: Indicate whether you have been in close contact with someone diagnosed with COVID-19 or if you have tested positive for the virus.

07

Step 7: If required, provide additional information or details as requested on the form.

08

Step 8: Once completed, review the form to ensure all information is filled out correctly and legibly.

09

Step 9: Sign and date the form where indicated.

10

Step 10: Submit the filled-out self-attestation form as per the instructions provided, which may include mailing, hand-delivering, or submitting electronically.

Who needs coronavirus self-attestation form?

01

Anyone who is required to undergo screening or testing for coronavirus or needs to provide their health status to an employer, educational institution, travel agency, or any other relevant authority may need to fill out a coronavirus self-attestation form. This may include individuals with recent travel history, symptoms related to COVID-19, or known contact with infected individuals.

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What is coronavirus self-attestation form?

Coronavirus self-attestation form is a document where individuals confirm their health status and potential exposure to COVID-19.

Who is required to file coronavirus self-attestation form?

Individuals who have been exposed to COVID-19 or are experiencing symptoms are required to file coronavirus self-attestation form.

How to fill out coronavirus self-attestation form?

To fill out coronavirus self-attestation form, individuals need to provide information about their symptoms, exposure history, and recent travel.

What is the purpose of coronavirus self-attestation form?

The purpose of coronavirus self-attestation form is to track and monitor the spread of COVID-19, identify potential cases, and take necessary precautions.

What information must be reported on coronavirus self-attestation form?

Information such as symptoms experienced, exposure to COVID-19, recent travel history, and contact details must be reported on coronavirus self-attestation form.

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