Negative CoVID-19 Employee Reporting

Negative CoVID-19 Employee Reporting

Please upload your negative CoVID-19 results and a Risk Management member will contact you.
Name *

First Name Last Name
Employee ID *
Email *
if no email, place N/A
Phone Number *
Please enter a valid phone number.
Position/Title *
Campus/Department *
Principal/Supervisor *
What was your reasoning for testing? *

Experiencing Symptoms Exposed International Travel Precautionary testing (no symptoms and/or exposure) Previously tested positive 10-day testing requirement
How were you exposed? *

In-District STUDENT Exposure In-District STAFF Exposure Outside District Exposure (family/household/friend) Unknown or N/A
Did you quarantine? *

Yes No
Date of exposure/start of symptoms OR date you began your quarantine *

Month Day Year
Did you work remote during your quarantine? *

Yes No
Did you apply for FFCRA? *

Yes No
Upload Negative CoVID Results *

Cancel of
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