Mercyhurst University

      14-Day Quarantine Travel Disclosure Form

      If you recently traveled to an area considered high risk for COVID-19 and been directed “self-quarantine” at home for a period of 14-days, follow these guidelines.

      General Directions:
      •  Stay home.  Allow family and friends to pick up groceries, pharmacy items, and supplies for you.
      • Stay in a specified room and area that allows you to keep a physical distance from others in the home.
      • If available, use a separate bathroom which other family members will no longer use.
      • If you must share a bathroom, wipe down surfaces that you have touched before you exit the bathroom.
      • Avoid having visitors come to the house during this time, regardless of whether they are there to see you or others in the family.  If someone must come by, have them stay outside of your area of the house.  If they must enter it, maintain 6 feet of personal space. 
      • Do not take walks through the neighborhood.  If your backyard is large enough that you are well-separated from neighboring homes, you can periodically sit outside or work in the yard. Select times when neighbors are not outside; go inside if they come outside.
      • If you live alone, ask friends and family to pick up supplies for you. Set up times to talk by phone; have an emergency contact.
      Monitor your health daily:
      • Take and record your temperature daily as well as monitor your general health.  If you develop a fever (100.4 F or more), or a cough, or difficulty breathing, call your healthcare provider for medical advice the same day.  Advise them of your recent travel history and your symptoms.
      • Do not use public transportation to go to the doctor.  This includes taxis, and ride sharing.
      • Practice healthy habits while at home.  Eat nutritious foods, stay active, maintain a good sleep schedule.
      • Reduce stress or boredom by keeping an active daily routine. Talk and laugh with others in the house, use your computer/phone to stay connected to friends, read, tackle projects within your defined household area.
      • If others in the house are coughing, sneezing, or have a fever, they should wear a facemask when around you.
      If you are or become sick:
      • If you develop a fever (100.4 F or more), or a cough, or difficulty breathing, call your healthcare provider for medical advice the same day.  Advise them of your recent travel history and your symptoms.
      • If you are coughing, sneezing or have a fever, you should wear a facemask when you are around other people (e.g., sharing a room or vehicle) or pets and before you enter a healthcare provider’s office. 
      • If you cannot medically tolerate a face mask (i.e. you can’t breathe well with one on), other household members should wear one when around you.
      • Call 911 if you have a medical emergency. Notify the 911 personnel that you recently traveled to an area where you may have been exposed to COVID-19.  Explain you are in the process of a 14-day quarantine period and describe who directed you to do so. If you have a fever or cough or trouble breathing, put a face mask on if possible before emergency personnel arrive.
      Cough and Cover:
      • Cover: Cover your mouth and nose with a tissue when you cough or sneeze.
      • Dispose: Throw used tissues in a lined trash can.
      • Wash hands: Immediately wash your hands with soap and water for at least 20 seconds or, if soap and water are not available, clean your hands with an alcohol-based hand sanitizer that contains at least 60% alcohol.
      Wash your Hands Often:
      • Wash hands: Wash your hands often with soap and water for at least 20 seconds, especially after blowing your nose, coughing, or sneezing; going to the bathroom; and before eating or preparing food.
      • Hand sanitizer: If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol, covering all surfaces of your hands and rubbing them together until they feel dry.
      • Soap and water: Soap and water are the best option if hands are visibly dirty.
      • Avoid touching: Avoid touching your eyes, nose, and mouth with unwashed hands.
      Avoid Sharing Personal Household Items:
      • Do not share: You should not share dishes, drinking glasses, cups, eating utensils, towels, or bedding with other people or pets in your home. 
      • Wash thoroughly after use: After using these items, they should be washed thoroughly with soap and water.
      • Clean and disinfect: Practice routine cleaning of high touch surfaces.
      Clean all High Touch Surfaces Daily:
      High touch surfaces include counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables.
      • Disinfect areas with bodily fluids: Also, clean any surfaces that may have blood, stool, or body fluids on them.
      • Household cleaners: Use a household cleaning spray or wipe, according to the label instructions. Labels contain instructions for safe and effective use of the cleaning product including precautions you should take when applying the product, such as wearing gloves and making sure you have good ventilation during use of the product.
      • Seek medical attention: Seek prompt medical attention if your illness is worsening (e.g.,
      • Wear a facemask when sick: Put on a facemask before you enter the facility. These steps will help the healthcare provider’s office to keep other people in the office or waiting room from getting infected or exposed.
      Ending Home Quarantine:
      • Signs of Illness:  If you developed signs of illness during this time, contact your healthcare provider to determine if you should continue staying home past the 14-days.
      • Stay at home until instructed to leave:  Anyone in the home coughing or sneezing due to colds or other areas should wear a mask to protect others from droplets and should maintain increased distance from you.
      (This information taken from the Centers for Disease Control)

      Registration is no longer available.