Employee COVID-19 Notification Form
Submission for Positive COVID-19 Test
Enter date of test for COVID-19
Click below to upload a copy of your positive test results for COVID-19 provided by your testing center. NOTE: If you have not received a copy of your results, you can submit them via email at a later date to email@example.com.
Drag and drop files here
Choose a file
Has the Alabama Department of Public Health (ADPH) been notified of your positive test result?
I do not know.
"Close Contact" is defined by the CDC as being within 6 feet of an individual for more than 15 minutes without an N-95 mask. Please list the names of any individuals you have been in "close contact" with while on campus. If none, type N/A.
When notifying individuals listed above that they have had direct exposure to someone who tested positive for COVID-19, do we have permission to share your identity? NOTE: This would only be shared with those listed in the question above.
Yes, you can share identity.
No, I prefer you didn't.
If able, do you plan to work remotely? (Must be able to perform essential functions and have approval of supervisor/dean.)
Unsure, working with supervisor to determine if able.
Should be Empty: