Weekly COVID-19 Rapid Testing Program Participant Report

This report is to be completed on the Monday of each week.

Please provide the requested information below, specifying the company's use and results of rapid tests in your organization's screening program. For companies with multiple testing sites, you must fill out a separate form with the results from each testing site.

Question Title

* 1. Company Information

Company Name

Primary contact name

Primary contact phone

Primary contact email

Number of tests received (cumulative)

Reporting date

Question Title

* 2. Testing Information
Note: If there are no results in a category, please enter zero (0). If the information is not available, indicate that it is not available (N/A).

Site name(s) and location

Number of tests used/administered

Number of positive results

Number of inconclusive results

Number of expired tests

Locations of tests used (city/town)

Question Title

* 3. PCR Testing
Note: If there are no results in a category, please enter zero (0). If the information is not available, indicate that it is not available (N/A).

Number of positive results confirmed by PCR testing

Number of negative results from PCR testing

Number of results untested by PCR

Number of unknown PCR testing statuses

Question Title

* 1. Company Information

Question Title

* 2. Testing InformationNote: If there are no results in a category, please enter zero (0). If the information is not available, indicate that it is not available (N/A).

Question Title

* 3. PCR TestingNote: If there are no results in a category, please enter zero (0). If the information is not available, indicate that it is not available (N/A).

Question Title

* 4. Additional Notes(Challenges, feedback, information etc.)

* 2. Testing Information
Note: If there are no results in a category, please enter zero (0). If the information is not available, indicate that it is not available (N/A).

* 3. PCR Testing
Note: If there are no results in a category, please enter zero (0). If the information is not available, indicate that it is not available (N/A).

* 4. Additional Notes
(Challenges, feedback, information etc.)