Covid-19 Employee Reporting Form
Please fill out this form if you are a WSD employee who has tested positive for Covid-19. If you also have students or close family members in the same household who have also tested positive, there is a section for you to list other WSD students and employees. Thank you!
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Employee's First and Last Name *
Employee's date of birth *
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Employee's Place of Employment *
Date tested positive *
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Date Covid-19 symptoms began *
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Where were you tested? *
Date you were last at work: *
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Are there other WSD students or employees in your household who have also tested positive for Covid-19?
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