COVID Test Reporting - Employee - Westchester Community College

COVID Test Reporting – Employee

Please complete this form if you have been tested for COVID-19 in the past 10 days. Please note that all information entered will remain confidential.

What was the date of your COVID-19 test? *

What type of test did you take? *

PCR (ie, results arrive in 2-10 days)

Point of Care Test (ie, Rapid Test - results arrive within 3 hours)

Pool Test (ie, Saliva)

Other (please specify

If other, please specify

What was the result of the test?

positive

negative

Have you been mandated to isolate (ie, NO interaction with anyone)? *

Yes

Have you been mandated to quarantine (ie, some interaction with household members allowed)? *

Yes

Have you been advised to quarantine as a precautionary measure? *

Yes

Please estimate the number of people that were potentially exposed to you while you were COVID positive. *

Have you been hospitalized due to COVID-19 within the past ten (10) days? *

Yes

If Yes, which hospital were you admitted to?

Were you physically present on the WCC main campus in Valhalla over the past 14 days? *

Yes

What was the last date you were physically present on the WCC main campus in Valhalla? *

Were you physically present in a WCC extension site (Ossining or EOC) over the past 14 days? *

Yes

What was the last date you were physically present in a WCC extension site (Ossining or EOC)? *

Do you know or think you know the source of a positive case that you were exposed to?

Yes

If yes, please specify

Has the Department of Health (County or NYC) been notified of your positive result? *

Yes

First Name *

Last Name *

Role

Administrator

Faculty

Staff

Email *

Captcha *

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