Covid Notification Report Form

Date: 07/01/2022

  • This form is intended for use by Building Coordinators to report that notification has been completed.
  • Do NOT include the name of the employee with a COVID-19 positive lab test, symptoms, or exposure.

Supervisor Information

Notification Information

* Message Template(s) used for notifying close contacts
Message Example 1
Message Example 2

Type the text from the image into the space below.

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