COVID-19 Test Reporting and Covid Card Upload Form
Employees
Employee Name
*
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Date recent Test was taken
*
-
Month
-
Day
Year
Date
Upload your:
COVID-19 Test Results
Doctors exemption form
Religious exemption form
VACCINATION CARD
Upload files
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Submit
Purpose for Testing
Medical check-up weekly compliance to work
Should be Empty: