St. Johns County
Board of County Commissioners
COVID Exposure Intake Form
COVID Exposure
Enter your Employee #:
*
Enter the last 4 digits of your SSN to validate:
*
What is the best phone number to call you?
Invalid Phone. Include Area Code.
How were you exposed?
Asymptomatic
Close Contact
Exposed
Symptoms
What are your symptoms?
Body Aches
GI Issues
Chills
Headache
Congestion
Loss of Taste/Smell
Coughing
Sinus/Runny Nose
Fatigue/Lethargy
Sneezing
Fever
Sore Throat
When did the symptoms start?
When was the last day that you worked?
Where are you currently working?
In Office
On Leave
Partial Leave/Partial Remote
Remote
Comments (enter any additional information regarding your current situation):
If you would like an email confirmation of this submission, please enter an email address: