Staff Consent Form - Albany Area Schools COVID-19 Onsite Testing

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Please carefully read the following informed consent:

1. I authorize Albany Area Schools and/or an independent laboratory acting on Albany Area Schools’ behalf to conduct collection and testing for COVID-19 as a part of the Minnesota Department of Health school COVID-19 testing programs. I understand that this testing is voluntary and I may choose to not test or test at another lab if I so desire.

2. I authorize my test results to be disclosed to Albany Area Schools COVID-19 testing staff, Health Office staff, Administration and Human Resources. I authorize my test results to be disclosed to any applicable county, state, or other governmental entity as may be required by law, and understand that such disclosure will also be made consistent with applicable law. This information will only be shared on a need to know basis.

3. I acknowledge that a positive test result is an indication that I must abide by Albany Area Schools isolation and quarantine policies and all applicable federal, state and/or local guidance on isolation and quarantine to avoid infecting others.

4. I understand that by signing this document and agreeing to undergo COVID-19 testing that I am not creating a patient relationship with Albany Area Schools. I understand that Albany Area Schools is not acting as my medical provider. Testing does not replace treatment by my medical provider. I assume complete and full responsibility to take appropriate action with regards to my test results. I agree I will seek medical advice, care and treatment from my medical provider if I have questions or concerns, or if my condition worsens.

5. I understand that, as with any medical test, there is the potential for false positive or false negative test results to occur.

6. By signing this form, I acknowledge that I have received a copy of Albany Area Schools Policy 406 - Public and Private Personnel Data (https://bit.ly/3oEFjNh)

7. I understand that this consent form will stay in place until June 15, 2022 for future testing needs and I do not need to resubmit this form during the time from the date signed until June 15, 2022. I can rescind my consent at any time by notifying Albany Area Schools Human Resources.

Email *

Full First & Last Name *

Date of Birth *

YYYY

Building *

Albany Elementary

Avon Elementary

Middle School

High School

Acceptance

I, the undersigned, have been informed about the test purpose, procedures, possible benefits and risks, and I have received a copy of this informed consent. I have been given the opportunity to ask questions before I sign, and I have been told that I can ask other questions at any time. I voluntarily agree to testing for COVID-19.

By typing my name below, I understand and agree that this form of electronic signature has the same legal force and effect as a manual signature. *

Today's Date *

YYYY

A copy of your responses will be emailed to the address you provided.

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