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Negative COVID-19 Test Reporting Form Template

Streamline the Reporting of Negative COVID-19 Test Results

Gathering proof of negative COVID-19 test results shouldn't be a headache. This template is designed to help organizations and employers efficiently collect and manage test reports from employees or participants. You'll benefit from quick data collection, improved safety compliance, a centralized reporting system, hassle-free record-keeping, and a user-friendly interface, all while ensuring your forms are WCAG-aligned for accessibility. Explore the live template to get started.

Use this Template (FREE) Live Preview
Your full name
Email for confirmation (optional)
Who are you reporting for?
Myself
Someone else (e.g., dependent)
On behalf of an organization
Full name of the person tested
Country or region of residence
Test date
What type of COVID-19 test was used?
Rapid antigen (self-test)
PCR/NAAT
LAMP
Not sure
Other
Please Specify:
Where was the test taken?
At home
Clinic/Healthcare facility
Workplace
School/University
Community testing site
Other
Please Specify:
Test brand or manufacturer (optional)
Was your COVID-19 test result negative?
Yes
No
Were you experiencing any COVID-like symptoms at the time of testing?
Yes
No
Not sure
Prefer not to say
What was the primary reason for taking this test?
Routine screening
Exposure to a COVID-19 case
Required for work or school
Travel requirement
Before a healthcare visit
Symptoms
Prefer not to say
Other
Please Specify:
Do you consent to share this de-identified result with local public health partners?
Yes
No
Type your full name as a signature
Date of signature
I certify the information provided is accurate to the best of my knowledge and I am authorized to submit it.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
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Paper art illustration of a negative COVID-19 test reporting form on a colorful background

When to use this form

Use this template when you need staff, students, or volunteers to report a recent negative COVID-19 test before returning to work, class, travel, or events. It helps HR teams, school health offices, and organizers collect consistent details, verify timing, and securely store proof like a lab PDF or a clear test photo. You get faster approvals and fewer back-and-forth emails, while submitters know exactly what to provide. TB Skin test results form is available if you also track other screenings in the same workflow. Release of information form lets you authorize your organization to request or share lab documentation when needed.

Must Ask Negative COVID-19 Test Reporting Questions

  1. What type of COVID-19 test did you take (PCR/NAAT or antigen)?

    Different policies accept different test types. Knowing the method sets the right return-to-work or entry criteria.

  2. When was your sample collected, and when did you receive the result?

    Timing confirms the result is within the required window (for example, 2472 hours). It also helps schedule clearances and follow-ups without delays.

  3. Where was the test performed, or which at-home brand/manufacturer did you use?

    Listing the clinic, lab, or test brand adds traceability. It lets reviewers validate the source if questions arise.

  4. What is the documented result and any reference number (accession, report ID, or kit lot)?

    A clear negative result tied to a unique identifier prevents mix-ups and speeds verification. Medical record certification form can support organizations that require a certified statement.

  5. Can we store your report and share it with your employer or school for verification, and if so, for how long?

    Consent and retention details help you meet privacy and recordkeeping rules. Clear permission reduces delays and ensures only authorized parties see your information.

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