EmailMeForm
COVID-19 Status Update
Use this form to report COVID-19 status to ABAS
Name
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First
Last
Email
*
Phone
*
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Today's Date
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MM
/
DD
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YYYY
Date of reported activity
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MM
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DD
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YYYY
Do you or someone in your household have any of the following symptoms?
Fever or chills
Cough
Shortness of breath or difficulty breathing
Fatigue
Muscle or body aches
Headache
New loss of taste or smell
Sore throat
Congestion or runny nose
Nausea or vomiting
Diarrhea
I am reporting:
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COVID-19 Screening Failure
Positive COVID-19 diagnosis
Negative COVID-19 diagnosis
Close contact with someone diagnosed with COVID-19
Travelled to a COVID-19 afected area in the past 14 days
Other
Quarantine notice
I have received new or updated isolation orders
Date of Quarantine Expiration
MM
/
DD
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YYYY
Look for emergency warning signs for COVID-19.
If someone is showing any of these signs, seek emergency medical care immediately:
-Trouble breathing
-Persistent pain or pressure in the chest
-New confusion
-Inability to wake or stay awake
-Pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone
Call your medical provider for any other symptoms that are severe or concerning to you.
