COVID-19 Exposure Tracking
This form will be used to collect information about exposure risk within the Region. Please provide all relevant information. You may be contacted for additional information if we are unable to make an exposure risk determination.
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Email *
Contact Name *
Person(s) Exposed *
Required
Date of Exposure *
MM
/
DD
/
YYYY
Has a COVID-19 test been completed? *
If yes, what was the date of the test?
MM
/
DD
/
YYYY
If yes, what was the result of the test? *
Date symptoms started
MM
/
DD
/
YYYY
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