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Employee COVID -19 Reporting Form


College of the Albemarle promotes and maintains a safe and healthful learning/working environment for our students, faculty, staff, and visitors. The College is closely monitoring local, state, and national health guidance related to the novel coronavirus (COVID-19).

Please refer to the College of the Albemarle COVID-19 resource website for additional information.

THIS FORM IS FOR EMPLOYEES (FACULTY, STAFF, STUDENT WORKERS) TO NOTIFY THE COLLEGE IF THEY ARE EXHIBITING SYMPTOMS OF / HAVE BEEN IN CLOSE CONTACT WITH A POSITIVE CASE / DIAGNOSED WITH / OR TESTED POSITIVE FOR COVID-19, THE NOVEL CORONAVIRUS.

EMPLOYEES COMPLETING THIS REPORT MUST STILL NOTIFY THEIR SUPERVISOR.

To report on behalf of a student please use the STUDENT COVID REPORT.

Background Information

Please report any of the following situations:
- Currently experiencing symptoms of COVID-19,
- Need to quarantine due to close contact with a positive case of COVID-19,
- Diagnosis by a Licensed Healthcare Professional for COVID-19,
- Positive test result for COVID-19, and/or
- Caring for someone who was diagnosed with or tested positive for COVID-19.

 
Email address must be of a valid format.
This field is required.

Involved Parties

Involved party 1

Questions

College Affiliation(Required)
You must make at least one selection.
Who is completing this form?(Required)
You must make at least one selection.
I am reporting:(Required)
You must make at least one selection.
Has there been a test for COVID-19?(Required)
You must make at least one selection.
This field is required.
This field is required.
Symptoms of COVID-19 currently being experienced. Check all that apply. Additional information on COVID-19 Symptoms(Required)
You must make at least one selection.
What actions have been taken?
You must make at least one selection.
Current status:(Required)
You must make at least one selection.
This field is required.
This field is required.
This field is required.
Affected individual's current location?(Required)
You must make at least one selection.
This field is required.
Is the affected individual able to perform their job duties from an alternate work location during period of quarantine/isolation?(Required)
You must make at least one selection.
This field is required.

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission