Coronavirus Positive Case Report

Name*
First Last
Phone
Email*
Division*
Who is the positive case regarding?*
Is your supervisor aware of this case?*
Name of the COVID-19 Positive Individual*
First Last
This is confidential and will only be submitted to HR and the Executive Office, as per HIPPA regulations.
When was the last time this person was in the ODAFF Building?*
Which floor is the individual's desk located?*
Please list any individuals this person may have been in contact with
Any additional information we may need to know?
CAPTCHA
Comments
This field is for validation purposes and should be left unchanged.