EightCAP Inc, Weekly COVID Test Result Reporting Form

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

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

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Date
Date of Results: *

Month Day Year
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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