Employee Self Report

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Please submit the form below for all issues related sick leave including requests for testing.*** You must contact the personnel office to receive permission to return to work.*** Be sure to click the last button and have a copy emailed to your account for your records. Thank you for keeping us informed so that we can help,

Email *

Untitled Title

Employee Last name* *

Employee First Name *

Please include a phone number and email where you can reached: *

Date of birth. *

YYYY

Address. *

Location *

What is your position in the district? *

You are informing CCISD that : Please check all that apply *

I have tested positive for COVID 19.

Other, please contact Angela Tullos @ tullosa@calcoisd.org

Required

Date symptoms First started *

YYYY

Type of Test *

At home test

Lab Confirmed Test

Date of test *

YYYY

What day were you last at work or near employees/students.

You will be contacted by the personnel office to determine the next steps. You must have the approval to return to work from the personnel office. *

In understand I MAY NOT work from home unless I receive written permission from the Personnel Office .

Required

A copy of your responses will be emailed to the address you provided.

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