Please enable JavaScript in your browser to complete this form.Date Group Leader/PI Name and Affiliation *I have read and understand the 'FIO Operations COVID Reopening Actions & Expectations' and have reviewed the 'Medical Facilities in Monroe County' documents on the FIO/KML Website *AcknowledgeAll persons in this group are covered by either their home institution's insurance or have personal insurance for necessary medical treatment *AcknowledgePlans for isolation and quarantine of individual(s) of concern until departure:Plans for diagnostic testing (if necessary):Plans for accessing medical care if needed (local urgent care, hospital, health department, etc.) Plans for safe return to home facility or local off-site housing: We understand the inherent risks are assumed by our institution, group leader/PI, and all individuals, as KML staff cannot offer support in the event of KML closure to isolate and quarantine *AcknowledgeE-Signature *To be completed by KML Staff:Reviewed and approved by: Date Submit
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