COVID-19 Test Reporting and Covid Card Upload Form
Employees and job applicants
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Date of recent vaccination shot or test taken
*
-
Month
-
Day
Year
Date
Upload your:
VACCINATION CARD
COVID-19 Test Results
Doctors exemption form
Religious exemption form
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: