COVID-19 Reporting Professional Staff - COVID-19 Reporting Form Name(Required)Email(Required) Today's Date(Required) MM slash DD slash YYYY Supervisor's Name(Required)Vaccination Status:(Required)-Select-Fully vaccinated & boosted (received a Covid 19 booster at least 48 hours ago)Fully vaccinated, but not boosted (2 weeks after second dose of Pfizer or Moderna, or 2 weeks after one dose of J&J)Not fully vaccinated (received one dose of Pfizer or Moderna, or within 2 weeks of final dose of any vaccine, or unvaccinated)I am reporting:(Required)-Select-Symptoms of Covid (fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, sore throat, loss of taste or smell, congestion or runny nose, nausea or vomiting, diarrhea)Positive for Covid (a positive rapid or PCR test)High-risk exposure (6 feet or closer to someone who is Covid positive for 15 minutes or more while at least one person is unmasked)Continuous high-risk exposure (employee cannot effectively quarantine from the Covid positive individual, such as a dependent household member who has Covid and cannot properly isolate)Date of symptom onset:(Required) MM slash DD slash YYYY Date of positive test:(Required) MM slash DD slash YYYY CAPTCHANameThis field is for validation purposes and should be left unchanged.