Employee COVID-19 Notification Form
Submission for Positive COVID-19 Test
Name
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First Name
Last Name
Email Address
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Enter date of test for COVID-19
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-
Month
-
Day
Year
Date
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 aosborn@suscc.edu.
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Has the Alabama Department of Public Health (ADPH) been notified of your positive test result?
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Yes
No
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.
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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.
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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.)
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Yes
No
Unsure, working with supervisor to determine if able.
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