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COVID Employee Reporting Form

This reporting form is for EMPLOYEES to notify the College if they have been diagnosed with COVID-19 by a medical provider or have been advised to self-quarantine due to a COVID-19 exposure.

COVID-19 Identification Form - Employee

  • please include specific location of suspected COVID exposure
  • Please provide information regarding additional person(s) believed to have been in close contact with you and could be affected by COVID-19

    Close contact is defined as exposure within a 6-foot radius for longer than 15 minutes.
  • Please provide additional information

  • (Please provide calendar dates)
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