Covid-19 Test Results

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Greetings friends,
Many members are concerned that the COVID-19 contact tracing procedures in their district and/or health departments are not sufficient. Many members who have been asked to get tested fear that not enough people in their buildings are being notified in a timely manner. We hope this survey works as a tool to connect and keep people updated. Names, phone numbers, and emails WILL NOT be made public or otherwise shared.

Email *

First and Last Name *

Cell Phone Number *

Name of Local *

What building(s) do you work at in your district? *

I was advised to get tested for COVID-19 and/or self isolate after being notified that I was in close proximity to someone who tested positive while in the workplace.

Yes

Clear selection

I have tested positive for Covid-19 and believe it was contracted in the workplace.

Yes

Clear selection

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of WEAC Region 3. Report Abuse

Forms