Create a Website Account - Manage notification subscriptions, save form progress and more.
Effective September 17, 2021, pursuant Contra Costa Health Services Order No. HO-COVID19-53, first responders are mandated to obtain weekly testing for COVID-19 or provide documentation of their fully vaccinated status.
Instructions for unvaccinated police officers: Complete the form below to record weekly COVID-19 testing results. If you have any questions, please contact Human Resources directly by emailing email@example.com or calling (510) 215-4315.
I attest that I am providing accurate information about my test results. I hereby affirm that I have accurately and truthfully recorded the information above. By completing and submitting the online version of the Employee COVID-19 Test Results Self-Attest Form, this signifies my signature.
This field is not part of the form submission.
* indicates a required field