WV School Employees Diagnosed with COVID-19

If you are a school employee who has gotten COVID-19, please complete this form.

Name

County of Employment

Job Title/ Position

Are you an AFT-WV member?

Yes

Personal (Non-school system) e-mail

Phone Number

Home Address

Please list the date you tested positive for COVID-19?

Do you believe you contracted COVID-19 at your school or workplace?

Yes

If you answered "yes" to the question above, why do you believe you contracted COVID-19 at your workplace?

Were you identified during contact tracing as someone who had been in contact with a COVID-19 positive individual?

Yes

How long were you off work due to your COVID-19 diagnosis?

Do you suffer from any comorbidities or pre-existing conditions (heart issues, asthma, diabetes, obesity, etc)?

Since your COVID-19 diagnosis, have you experienced any long term health effects? If yes, please describe.

Cancel