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Request for Rapid Antigen COVID Testing

The form must be completed by an HESD Manager requesting a Rapid Antigen COVID test for an employee.

Required

Name of Employee needing a Rapid Antigen Testrequired
First Name
Last Name
Siterequired
Employee Work Email Addressrequired
Employee Cell Phone:required
Symptomsrequired
Reason for testingrequired
Requesting Manager's Namerequired
First Name
Last Name