Vacation Newport - RI Certificate of Compliance

STATE OF RHODE ISLAND CERTIFICATE OF COMPLIANCE
OUT-OF-STATE TRAVEL QUARANTINE/TESTING REQUIREMENTS

As a result of nationwide COVID-19 transmission, visitors coming to Rhode Island for a non-work-related purpose from a state with a high community spread rate, as set forth on this list of states maintained by the Rhode Island Department of Health (RIDOH) at https://health.ri.gov/covid/, must, upon arrival, either self-quarantine for 14 days or present a negative COVID-19 test according to the options below.

Reservation Holder's Full Name: *

Property You Are Staying At: *

Unit Number:

Date of Arrival: *

Telephone: *

Home Address: *

I have reviewed and attest that (1) I am completing this form for myself and any persons in my care who are under the age of 18 or who are dependent on my care, and (2) that the below certifications I am making are accurate.

Please select an option below that best describes your planned arrival in Rhode Island.

Option 1:

I WILL NOT be traveling to RI from a state determined by RIDOH to have a high community spread rate, as listed above, in the last 14 days.

Option 2:

I WILL travel to RI from a state determined by RIDOH to have a high community spread rate, as listed above, in the last 14 days and attest that I have taken one of the following actions:

COMPLETE ONLY IF YOU SELECTED OPTION 2 ABOVE.

If you selected Option 2 above please select your planned action to comply with out-of-state traveler quarantine/testing requirements:

I am quarantining for 14 days.

I will receive a negative COVID-19 test result 72 hours prior to arrival in RI and I understand that I may be asked to furnish proof of the negative test upon request.

I will take a COVID-19 test upon arrival in RI and I will remain in quarantine until I receive a negative test result. I understand I me be asked to furnish proof of negative result upon request.

I will take a COVID-19 test within 72 hours arrival in RI and I will remain in quarantine until I receive a negative test result.

I understand that if I receive a positive COVID-19 test result, from any state, that I must comply with the self isolation requirements in Executive Order 20-20. Additionally, if I have been in known close contact with a person who has tested positive for COVID-19, I must self-quarantine for 14 days following that contact in accordance with Executive Order 20-20. Individuals who are self-quarantining should complete a selfquarantine questionnaire, available at www.health.ri.gov/oos-covid. Additionally, If the above attestation is no longer accurate, I will update this Certificate of Compliance.

You must agree to the above: *

I agree to all of the above.

I plan to take a COVID-19 test while in RI and I will remain in quarantine until I receive a negative test result. I understand I me be asked to furnish proof of negative result upon request.

* indicates required information

First Name: (you must leave this field blank)
Last Name: (you must leave this field blank)