COVID-19 Notes for Employers - Medical Return-to-Work Templates

Aug 30, 2026

Employers receive printable physician/provider certification templates to support COVID-19-related return-to-work decisions. Forms cover multiple clinical situations, including patients potentially contagious who must stay home for 14 days, symptom tracking for those without testing, and work clearance for medically confirmed cases. Additional templates address confirmed infection with either resolving symptoms and two negative tests or confirmed infection with no symptoms after defined time periods. Each template includes patient identification, physician contact details, signature, and an effective return date.

LanguageEnglish

CategoryLetters

FormatDOCX

Pages5

Reading Time2 min

AccessFree to download

TEMPLATE 1A-POSSIBLY CONTAGIOUS

TEMPLATE 1B-POSSIBLY CONTAGIOUS

TEMPLATE 2 - SYMPTOMS WITHOUT TESTING

TEMPLATE 3- CONFIRMED AND SHOWING SYMPTOMS

TEMPLATE 4- CONFIRMED WITH NO SYMPTOMS

Insert Practice Information TEMPLATE #1A-POSSIBLY CONTAGIOUS Patient Name:_________________________________________________________________________ To whom it may concern, This certifies that the patient has been under our care for the symptoms potentially associated with COVID-19 and has been directed to stay home for 14 days since onset of the symptoms which may be contagious. Thank you for your understanding. Sincerely, Physician/Provider name: _____________________________________Phone Number:_______________ Physician/Provider signature: __________________________________________Date:________________ Insert Practice Information TEMPLATE #1B-POSSIBLY CONTAGIOUS Patient Name:_________________________________________________________________________ To whom it may concern, This certifies that the patient has been under our care for the symptoms below and has been directed to stay home for 14 days since onset of the following symptoms which may be contagious. Symptoms of concern are: ( ) Fever( ) Cough( ) Shortness of Breath( ) Body Aches( ) Fatigue ( ) Vomiting ( ) Diarrhea Thank you for your understanding. Sincerely, Physician/Provider name: ____________________________________Phone Number:_______________ Physician/Provider signature: ________________________________________Date:________________ Insert Practice Information TEMPLATE #2 - SYMPTOMS WITHOUT TESTING Patient name _________________________________________________________ attests that The patient had a fever and a cough without COVID-19 testing or medical care, and that Three days have passed since their recovery, fever has resolved without the use of fever-reducing medication and their respiratory symptoms have improved; and that At least seven days have passed since the patient first experienced symptoms; and the patient notified physician/provider Sincerely, Physician/Provider name: ____________________________________Phone Number:_______________ Physician/Provider signature: ________________________________________Date:________________ Insert Practice Information TEMPLATE #3- CONFIRMED AND SHOWING SYMPTOMS Patient name ___________________________________________________________________ Was medically confirmed to have COVID-19 and can now return to work since Their fever has been resolved without the use of fever-reducing medications; Their respiratory symptoms have resolved and They have had two negative COVID-19 tests. I certify that, with regard to COVID-19 the above-named patient is fit for duty and able to resume work effective_________________. Sincerely, Physician/Provider name: ______________________________Phone Number:_______________ Physician/Provider signature: ___________________________________Date:________________ Insert Practice Information TEMPLATE #4- CONFIRMED WITH NO SYMPTOMS Patient name ____________________________________________________________________ Was medically confirmed to have COVID-19 and can now return to work since 7 days have passed since the date of their first positive COVID-19 laboratory test and; The patient is not showing signs of illness and The patient has had no subsequent illness I certify that, with regard to COVID-19 the employee is fit for duty and able to resume work effective_________________. Sincerely, Physician/Provider name: ______________________________Phone Number:_______________ Physician/Provider signature: ___________________________________Date:________________

FAQs

When can an employee return to work according to TEMPLATE 3 and TEMPLATE 4?

TEMPLATE 3 requires medically confirmed COVID-19 with fever resolved, respiratory symptoms resolved, and two negative COVID-19 tests, plus a fit-for-duty certification with an effective return date. TEMPLATE 4 requires at least 7 days since the first positive lab test, no signs of illness, and no subsequent illness, also with an effective return date.

Aug 30, 2026

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