GA-11 and GA-12 Travel-Related Quarantine Exemption Form

If you or your Company falls within the essential services categories as defined by Texas Executive Order GA-14, you and your employees are automatically exempt from the travel-related quarantine requirement and are not required to apply for an exemption via this form.

As required by Governor Abbott’s Executive Orders GA-11 and GA-12, the Texas Division of Emergency Management will determine, on a case-by-case basis, whether the self-quarantine order applies to individuals traveling in connection with commercial activity, military service, emergency response, health response, or critical-infrastructure functions.

NOTE

Federal employees and their contractors are exempt from GA-11 and GA-12 if traveling for business purposes.
Individuals traveling for essential health care services (unrelated to COVID-19) with a doctors note are exempt and do not need to apply for an individualized exemption.

Company Description

Company Name *

Critical Infrastructure Sectors *

Company EIN Number *

Phone *

Email *

Website *

Company Headquarters Address *

Address Line 1

Address Line 2

City

State

Zip Code

Positions Requesting Exemptions

Position Title 1 *

Justification of Travel Exemption *

If there are more than 10 positions please list the additional positions and justifications below.

By submitting this form, you confirm that the listed information is accurate.

Phone