EightCAP Inc, Weekly COVID Test Result Reporting Form

EightCAP, Inc. Weekly COVID-19 Test Result Reporting For Employees with an Exemption
Date:*

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Date
Name:*
Work Location/Center:*
Results:*
Supervisor:*
Date of Collection:*

MonthDayYear
Date
Date of Results:*

MonthDayYear
Date
Type of COVID 19 Test:*
I attest that I have received a test result for COVID-19. The test was conducted on a specimen collected no more than 2 calendar days before my return to work on Monday. I understand that making a false statement on this form may result in disciplinary action, up to and including termination.
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