COVID-19: Testing Support for Confinement Facilities

The Wisconsin Department of Health Services (DHS) is pleased to support COVID-19 testing in confinement facilities (county jails and municipal lockups.) This testing support is subject to the availability of testing supplies and is intended to complement COVID-19 prevention efforts. Participation is voluntary.

Key definitions

Close contact: being within 6 feet of another person who has confirmed or suspected COVID-19 for a cumulative total of 15 minutes or more. If identifying a close contact is not feasible, location-based contact tracing may be used to identify whether Persons in our Care (PIOC) or staff were in the same location with an infected person. Strategies for everyday operations: COVID-19 prevention strategies that correctional and detention facilities should keep in place at all times, even when the COVID-19 Community Level is low. 
Enhanced COVID-19 prevention strategies: Additional COVID-19 prevention strategies for facilities to use when the COVID-19 Community Level is medium or high, or when facility-level factors indicate increased risk. 

Asymptomatic: a person who does not report or appear to have any symptoms or signs of illness.

Symptomatic: a person is exhibiting symptoms.

Quarantine: Physical separation of an individual who has had close contact with someone with confirmed or suspected COVID-19, to reduce the risk of transmission to others if the individual is later found to have COVID-19. 

Isolation: is used to separate people infected with COVID-19 from those who are not infected.

Molecular test: is a type of highly accurate diagnostic test that can detect an active COVID-19 infection. Samples for diagnostic tests are typically collected with a nasal swab, or saliva collected by spitting into a tube. Samples are usually sent to a lab for processing.

Antigen test: is a type of diagnostic test that can detect an active COVID-19 infection. Samples for diagnostic tests are typically collected with a nasal swab. Results are available in 15-30 minutes. Fo symptomatic people who test negative, or asymptomatic people who test positive, confirmatory molecular test is recommended.

Staff: All public or private sector employees working within a correctional or detention facility. “Staff” does not distinguish between healthcare, custody, food service, and other types of staff members, nor between government and private employers. 

Up to date: a person has received all recommended doses in their primary series COVID-19 vaccine, and any booster dose(s) when eligible.    

Confinement Facility Outbreak: An active outbreak is defined as two or more confirmed or probable cases within two weeks of each other by either onset date or specimen collection date. Both cases must be linked to the same facility. 

The Centers for Disease Control and Prevention (CDC) uses community and facility-level indicators when assessing COVID-19 risk and determining if increased prevention strategies are needed: 

  • Strategies for everyday operations, which should be used when risk is low 
  • Enhanced prevention strategies which should be used only at times of increased risk 

Assessing COVID-19 Risk in Correctional and Detention Facilities  
When developing a flexible, long-term COVID-19 prevention plan, correctional and detention facilities should first assess their unique COVID-19 risks to inform the intensity of prevention strategies needed over time. This risk assessment should be based on a combination of: 

  • CDC COVID-19 Community Levels 
  • Facility-level factors 

 
CDC COVID-19 Community Levels  
CDC COVID-19 Community Levels are categorized as low, medium, and high based on the number of COVID-19 cases in a given community and the impact of severe disease on community-based healthcare systems. Visit the CDC website to check any county’s current COVID-19 Community Level and to understand in more detail how transmission levels are determined. 

  • When correctional and detention facilities assess a local area’s COVID-19 Community Level, they should consider the community where the facility is located as well as the communities from which residents originate and where staff members live. 

 
Facility-level Factors 
Because COVID-19 community levels do not always reflect the COVID-19 risk in correctional and detention facilities, each facility should also assess facility-level factors that reflect its unique characteristics, operations, and populations to guide decisions about when to add or remove enhanced prevention strategies such as: 

  • Vaccination coverage 
  • Transmission in the facility 
  • Risk of severe health outcomes
  • Facility structural and operational characteristics 

 

Key reasons to test in Confinement Facilities

  • The Centers for Disease Control and Prevention suggests maintaining a robust testing program, including both diagnostic and screening testing, to prevent or reduce transmission of COVID-19.
  • Testing PIOC and staff who are symptomatic and close contacts helps enable rapid detection of cases in confinement facilities to reduce or prevent outbreaks. A routine screening testing program, which regularly tests people without symptoms or known exposures, is an optional tool to reduce “silent” spread of the virus and can help PIOC and staff. 
  • Testing in confinement facilities ensures PIOC and staff have convenient and equitable access to testing resources. 

Strategies for Everyday Operations 

  • Facilities should keep Strategies for Everyday Operations in place at all times. When a facility is operating at a Strategy for Everyday Operations level, testing should be 
  • conducted for: 
  • Symptomatic PIOC and staff. The CDC lists possible symptoms of COVID-19 as fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion, runny nose, nausea or vomiting, and/or diarrhea. This list does not include all possible symptoms. 
  • Close contacts of someone who has tested positive for COVID-19. Testing is recommended regardless of COVID-19 vaccination and booster status. 
  • All PIOC at intake or during a routine observation period 
    • Observation periods should be 7-10 days if residents are not tested at the end of the observation period.
    • A shorter period (minimum of 5 days) could be used if combined with testing at the end of the observation period. 
    • Diagnostic testing should be performed for PIOC and staff who show signs or symptoms of COVID-19 and for PIOC and staff who have been potentially exposed or identified as a close contact of someone with COVID-19, regardless of COVID-19 vaccination and booster status.  
    • Routine screening testing should be performed for all PIOC at intake and before transfer and release, regardless of COVID-19 vaccination and booster status. See Testing Considerations for SARS-CoV-2 for more information about testing strategies, including options for designing a screening testing program based on the unique features of a particular facility and its population. 

Because of the risk of unrecognized infection, a single new case of SARS-CoV-2 infection in PIOC or staff in a correctional or detention facility should be evaluated as a potential outbreak. If a PIOC tests positive at intake but has not had close contact with other members of the facility’s population and is immediately placed in medical isolation, the PIOC’s positive test result could be considered an isolated case rather than a part of a larger outbreak. However, it may be necessary to test other people who were exposed during intake or transport. 

Enhanced COVID-19 Prevention Strategies 


In addition to the strategies for everyday operations above, facilities should add enhanced COVID-19 prevention strategies when the COVID-19 Community Level is medium or high, or when facility-level factors indicate increased risk. 
Facilities should maintain the ability to add or remove enhanced COVID-19 prevention strategies based on ongoing risk assessments such as COVID-19 community levels and facility-level factors as described above. When shifting from a period of higher to lower risk, facilities should avoid removing enhanced COVID-19 prevention strategies all at once.  
If a facility is operating at an enhanced COVID-19 Prevention Strategy level, routine testing should be conducted for: 

  • Symptomatic PIOC and staff. The CDC lists possible symptoms of COVID-19 as fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion, runny nose, nausea or vomiting, and/or diarrhea. This list does not include all possible symptoms. 
  • Close contacts of someone who has tested positive for COVID-19. Testing is recommended regardless of COVID-19 vaccination and booster status. 
  • All PIOC at intake or during a routine observation period.
    • Observation periods should be 7-10 days if the residents under observation are not tested at the end of the observation period. A shorter period (minimum of 5 days) could be used if combined with testing at the end of the observation period. 
    • PIOC before transfer to a different facility 
    • PIOC before/after community visits 
    • PIOC before release 
       

Preparing for COVID-19 testing: step-by-step instructions

Testing supplies are available through the DHS COVID-19 testing supplies website.  

Highly accurate, lab-based molecular tests  

Laboratory-based molecular tests are the gold standard test. Conducted in a specialized environment by trained professionals, these tests are the most accurate tests available. These shelf-stable supplies must be return-shipped or couriered to the laboratory for resulting. Test results are usually available in 24-48 hours. The laboratory conducts all required certificates and reporting for facilities. 

Antigen Point-of-care Tests  

Antigen point-of-care tests are available for use in facilities and provide results in 15-20 minutes. Antigen point-of-care tests are the most accurate for PIOC and staff with symptoms. Confirmatory molecular testing is recommended (but not required) for asymptomatic PIOC and staff who test positive and symptomatic PIOC and staff who test negative. 

1. Obtain a CLIA Certificate of Waiver (only for rapid point of care tests)

When ordering point-of-care antigen tests from DHS, you will need to submit your CLIA Certificate of Waiver number. To obtain a CLIA Certificate of Waiver, you will need to submit a completed application to dhsdqaclia@dhs.wisconsin.gov

2. Partner with a clinician

All COVID-19 testing sponsored by this program needs to occur under the authority of a clinician with prescribing authority (MD, DO, PA, or NP). If you do not have a local clinician who manages your facility’s health services, you can complete the attestation form and submit to WICovidTest@Wisconsin.gov This will allow you to conduct testing under the statewide standing order for COVID-19 tests prescribed by the Wisconsin DHS Chief Medical Officer. 

3. Submit a request for testing supplies

To submit a request for testing supplies, visit Order free DHS testing supplies 

  • Select “Other Organizations”  
  • Input the reason for testing in the “Testing Plan” section   
  • Select “Correctional Facility/Jail” in the Facility Type  

To receive lab-based molecular tests in the "PCR Testing Supplies" section, enter the clinical laboratory name that you have been paired with (Example: Exact, Mako, Accelerated...)  

  • Note: If you have not been paired with a lab, please state in the "Note" section that you need to be paired with a lab  

To order both antigen point-of-care and lab-based molecular tests, complete both PCR Testing Supplies and Antigen Testing Supplies.   

  • Note: This option is for facilities paired with EXACT ONLY. Facilities not paired with EXACT need to place separate orders for Antigen and PCR Testing Supplies.  

4. Complete training

Any person who will administer COVID-19 testing in the facility must complete training to assure they are using the tests safely and effectively. 

Performing and Reporting Antigen Point-of-care Tests in Facilities 

Performing and Reporting PCR test in facilities 

 

5. Set up an account with the Wisconsin State Lab of Hygiene to report results

COVID-19 is a Category I reportable condition in Wisconsin. As such, test results must be reported to the State of Wisconsin and to federal authorities (HHS). To report results, set up an account
 
If you have questions about the COVID-19 testing support available to county jails or municipal lockup facilities, please email dhscovidtestingprogram@dhs.wisconsin.gov.

Resources to learn more

Frequently asked questions by category

Program background

  1. What support is the Department of Health Services providing facilities to conduct COVID-19 testing? The Department of Health Services offers free point-of-care testing supplies with optional confirmatory PCR supplies, shipping and courier services, diagnostic resulting and reporting to state and federal entities for both county jails and municipal lockup facilities. Additionally, county jails will have the option for specimen collection services through an assigned vendor. Tests may be used for PIOC and staff who are symptomatic and close contacts, to conduct screening testing, and to test PIOC who have appointments outside of the facility.
  2. Where can I find out additional information about testing in these facilities? If you are a municipal lockup facility interested in ordering supplies or a county jail interested in vendor services or have any general questions regarding COVID-19 testing, email dhscovidtestingprogram@dhs.wisconsin.gov
  3. Is it mandatory for facilities test PIOC and staff? No, participation i is voluntary. 
  4. Will the program offer facilities funding for additional staff in order to conduct testing? No. Direct funding to pay staff is currently not covered under this program. 
  5. How do I order point-of-care antigen tests under this program? Free point-of-care antigen tests may be ordered through the Wisconsin COVID-19 Collection Supply Request website. Facilities conducting testing must provide a valid CLIA Certificate of Waiver number during the ordering process. 
  6. Is the cost associated with biohazard waste disposal covered under this program? No. The cost of biohazard waste disposal is not covered under this program. Facilities are responsible for safely disposing of waste. For additional information, see CDC Waste Management Guidelines for SARS-CoV-2 Point of care Testing.

CLIA Certificate of Waiver

  1. When does a facility need a Clinical Laboratory Improvement Amendments (CLIA) Certificate of Waiver? For a facility to conduct point-of-care tests (like COVID-19 point-of-care antigen tests or diabetic glucose checks), the facility must apply for and receive a CLIA Certificate of Waiver. Facilities may not conduct testing until the certificate of waiver has been approved. A facility does not need a certificate of waiver if they collaborate with another entity willing to conduct testing at the  facility under that entity’s CLIA Certificate of Waiver or if the  facility is not conducting point-of-care tests. 
  2. What responsibilities must a facility fulfill as an organization with a CLIA waiver? Any organization with a CLIA Certificate of Waiver is responsible for the safety and effectiveness of services they provide. For facilities conducting COVID-19 point-of-care testing, this includes staff training, effective infection control practices, and reporting infectious disease test results to the State of Wisconsin and to the federal authorities (HHS). Guidance about how to set up an account and report COVID-19 point-of-care test results is available from the Wisconsin State Laboratory of Hygiene. If a facility coordinates with a testing partner or is providing lab-based molecular tests (not point-of-care tests), then the laboratory will assume the responsibility for the safety and effectiveness of testing – including responsibility for reporting test results on the facility’s behalf. 
  3. If a facility uses another company to conduct point-of-care antigen testing, does the facility still need to obtain a CLIA Certificate of Waiver? No. If the facility partners with an entity to come to their facility to swab and result the point-of-care antigen test, then the facility does not need to obtain their own CLIA certificate of Waiver. All testing would occur under the external entity’s CLIA certificate. The t facility should verify that the external entity conducting the test has a valid CLIA Certificate of Waiver. To find out if an entity has a valid CLIA Certificate of Waiver, request the CLIA number from the testing partner and verify it by checking the CDC CLIA Laboratory Search website or emailing dhsdqaclia@dhs.wisconsin.gov. All entities ordering point-of-care antigen test supplies from DHS are required to provide their CLIA number when placing their orders. 
  4. How does a facility apply for a CLIA Certificate of Waiver? To apply to receive a CLIA Certificate of Waiver, the facility must fill out the Center for Medicare and Medicaid Services (CMS) application form CMS-116 CLIA Application and submit it to the State of Wisconsin CLIA Section at dhsdqaclia@dhs.wisconsin.gov. Once approved, CMS will assign a CLIA number and send a letter or email of confirmation to the facility. For more information on CLIA certification, reference the CMS Laboratory Quick Start Guide
  5. How long does it take to process the CLIA Certificate of Waiver? Once a facility submits an accurate and complete application, the Wisconsin State Agency usually processes the Certificate of Waiver in one week or less. Once approved, the facility will be assigned a Federal CLIA number and may begin testing. Provide this CLIA number to DHS when ordering testing supplies. 
  6. Is there a fee associated with applying for a CLIA Certificate of Waiver? Yes. An entity is required to pay $180.00 to CMS. CMS will send an invoice to the  facility and they may submit payment to CMS directly or pay online at Pay.Gov
  7. Does the CLIA Certificate of Waiver expire? The CLIA Certificate of Waiver is good for two years. CMS will send a renewal invoice 6 months prior to the expiration date of the certificate. 
  8. The CLIA application asks to identify the "director" of the laboratory. Can this be anyone in the facility? The facility may list any employee as the director on the CLIA Application. It is recommended that the director is an individual who is or who will become knowledgeable about the requirements of maintaining the CLIA Certificate of Waiver and the facility’s testing operations, including testing and safety protocols, staff training, and reporting of test results. Examples may include: the facility nurse, a health aide, or a facility administrator overseeing the health or testing program. 
  9. What other information will the application request? The application requires the facility to provide their Tax ID number. The application also requires the facility to estimate the number of tests they plan to conduct. This can be a general estimate based on the number of staff and PIOC. 
  10. How can a facility verify whether they already hold a CLIA certificate? To verify whether an entity has a valid CLIA Certificate of Waiver, check https://www.cdc.gov/clia/LabSearch.html or email dhsdqaclia@dhs.wisconsin.gov
  11. Who do I contact if I have additional questions about the CLIA Certificate of Waiver process? For any questions about the CLIA Certificate of Waiver and process, email the State of Wisconsin Department of Health Services, Division of Quality Assurance at dhsdqaclia@dhs.wisconsin.gov.

Testing guidance

  1. Who at my facility is allowed to collect the specimen for a COVID-19 test? Does it have to be a nurse? Any staff member who is properly trained is allowed to collect the specimen and result the point-of-care antigen test. Training may be accessed through many venues, including from a trained clinician (a healthcare provider) or through the test manufacturer’s materials. If you need assistance finding these vendor materials, email WICovidTest@Wisconsin.gov

  2. Does a facility need to have access to lab-based molecular tests? All facilities conducting point-of-care testing under Dr. Westergaard's statewide standing order (including COVID-19 point-of-care antigen tests) must assure compliance with the DHS and CDC recommendation for providing follow-up testing to confirm some antigen results. Lab-based molecular tests are recommended for this follow-up testing. Facilities order and provide these follow-up, confirmatory tests, or refer staff to follow-up: 

  3. How should facilities prepare to test PIOC and staff on site? Facilities interested in offering onsite testing will need to assure the following: 

    • a process for notifying PIOC and staff of their results

    • necessary testing supplies including personal protective equipment, tables, and cleaning and disposal supplies

    • space to isolate PIOC with symptoms and who test positive

  4. Should facilities require a negative test result for PIOC to return to the general population or staff before returning to work after they have been sick? No. It is not recommended to require a negative test before returning. There have been reports that PIOC and staff can continue to test positive long after they are no longer contagious. PIOC and staff who test positive should observe a 10-day isolation period from the date their symptoms first appeared. Additionally, they need to be fever-free for 24-hours and have improved symptoms before they end their isolation period. Asymptomatic PIOC and staff should observe a 10-day isolation period starting on the date that symptoms began or the specimen collection date if they did not have symptoms. 

    For additional guidance on this topic: 

  5. When should a PIOC be referred for diagnostic testing?  

    • PIOC with symptoms, regardless of COVID-19 vaccination or booster status, should be moved to medical isolation in a separate environment from other people (ideally individually), medically evaluated, and tested. If the test result is positive, medical isolation should continue for 10 days. Multiple PIOC with confirmed COVID-19 can be housed as a cohort (in a dorm or cell environments) regardless of the date of their positive test result. Facility staff should carefully evaluate and support the mental health needs of PIOC during medical isolation. If PIOC test negative and did not have close contact with a suspect or confirmed COVID-19 case, then he/she can end isolation. 

    • Staff members with symptoms, regardless of COVID-19 vaccination and booster status, staff should be excluded from work and are advised to seek testing. If the test result is positive, staff members should be excluded from work for 10 days (However, staff may use the guidance for the general public for duration of isolation when they are not at work). See section below on isolation duration for staff during routine vs. crisis operations. If staff test negative and did not have close contact with a suspect or confirmed COVID-19 case, then he/she can end isolation.

    • Visitors with symptoms, regardless of COVID-19 vaccination and booster status, should be denied entry and encouraged to seek testing through their healthcare providers, at a free community testing site or local health department.

Medical order

  1. Does a facility participating in this state-sponsored program need an order signed by a medical provider to do testing? Yes, COVID-19 testing sponsored by this program needs to occur under the authority of a medical provider. A facility may obtain a written order through a clinician with prescribing authority (MD, DO, PA, or NP), or opt to use a standing order issued by Dr. Ryan Westergaard, Chief Medical Officer for the Wisconsin Department of Health Services. If a facility chooses to use Dr. Westergaard’s standing order, they must sign an attestation form agreeing to follow the requirements of the order. 
Last Revised: July 29, 2022

211 Wisconsin

Call 211 or 877-947-2211 to get referrals for thousands of services across Wisconsin. For COVID-19 questions, text COVID to 211-211. Language assistance is available.

Resilient Wisconsin

Get help learning how to manage stress and adapt to change with services and support from organizations across the state.

Helpful resources

Find help with housing, income, food, employment, health care, mental health concerns, safety at home, and more—in multiple languages.