Coronavirus (Covid-19) Exposure Form

Use this form if you have been exposed, or suspect you have been exposed to the Coronavirus (Covid-19). Also use this form to update any information from previous forms submitted.
  • Date Format: MM slash DD slash YYYY
  • Submitted By Information

    Select all that apply.
  • Coronavirus (Covid-19) Exposure Status

    This section is dedicated to clarifying your current status as it relates to having, had exposure or suspicion of exposure to the Coronavirus (Covid-19). Please answer all of the questions below.
  • Date Format: MM slash DD slash YYYY
    Select all that apply. IF you have tested positive and been diagnosed with the Coronavirus (Covid-19), please provide the diagnosis date below.
  • Date Format: MM slash DD slash YYYY
  • Provide names of individuals, relationship to you and their contact information if available.
Visits: 17