COVID-19 Positive Test Reporting Form

Background Information

Complete all fields to the best of your ability; please do not delay in submitting the form even if the information is incomplete.

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Your full name:

Your phone number:

Your Redlands email address:

Email address must be of a valid format.

Nature of this report(Required):

This field is required.

Date(Required):

This field is required.

Current Location(Required):

This field is required.

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Current location of the Covid-positive person.

Covid-Positive Employee

Name

ID Number (if known)

Phone number

Email address

Permanent Address

Questions

Complete all fields to the best of your ability.

What was the COVID-positive employee's test administration date?(Required) This field is required.

What was the COVID-positive employee's test result date?(Required) This field is required.

What was the COVID-positive employee's symptom onset date (if any)?(Required) This field is required.

What date was the COVID-19 positive employee last on a Redlands Campus?(Required) 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.

Email me a copy of this report

Background Information

Covid-Positive Employee

Questions

Supporting Documentation

Submission