Employee | Health Services COVID-19 Symptom Report

ETBU email address

Phone

Is a member of your household also employed at ETBU?

Please add the household member's name.

Who is your supervisor?

Select One

What date did you have your test?

Upload Picture of Positive Test Result

Unlimited number of files can be uploaded to this field.
75 MB limit.
Allowed types: gif, jpg, png, svg, jpeg.

**If you take an at home test, then you must write your name and test date on the test cassette for your test to be valid and accepted by the health clinic**