EmailMeForm
Positive COVID Test Notification
This is a confidential form to notify the Village Theatre COVID Safety Team of a positive COVID test.
A COVID Safety Manager will follow up with you shortly.
Please isolate for a minimum 5 days as recommended and follow CDC guidance:
https://www.cdc.gov/coronavirus/2019-ncov/your-health/quarantine-isolation.html
There may be additional requirements for Production Testing Group members.
Name
*
First
Last
Email
*
Department
*
Please select
Advancement
Artistic
Costumes & Wigs
Finance
KIDSTAGE
Operations
Patron Services
Production
Production Testing Group
Tech Studios
Other
Primary Location
*
Everett
Issaquah
Which best describes your role?
*
Staff
Contracted Artist
Overhire
Student (includes cast/youth production team member)
Intern
Volunteer
Are you part of a specific Village Theatre production or project?
Yes
No
If Yes, please specify:
Last day onsite at Village Theatre
*
MM
/
DD
/
YYYY
Areas you visited while onsite at Village Theatre
*
Date of Positive Test
*
MM
/
DD
/
YYYY
Type of Test
Antigen Test
PCR Test
Other
Are you experiencing COVID symptoms?
*
Yes
No
Date Symptoms Began (if present)
MM
/
DD
/
YYYY
Did you have Close Contact with others at Village Theatre (within 6' for 15+ minutes over a 24 hour period)?
Yes
No
If Yes, please let us know which individuals we should reach out to directly:
Other Comments
