COVID 19 Consent Form

COVID 19 Consent and Release of Information

I understand that I am to submit a shallow nasal mucus specimen for antigen testing for the COVID 19 virus and that the testing results will be reported back to my company as per my company contract.

First Name

Last Name

Company

I understand that my test result are the property of my company and are not to be utelized outside of company business.

Yes

I understand that I am to complete the testing honestly and without compromise in order to obtain a valid testing result

Yes

I understand that TestTech Occupational Testing Solutions Inc is not to be held legally responsible in the event of a Positive Covid Result and that any further steps taken in the event of a positive result are that of the company and not that of TestTech OTS Inc

Yes

I declare that the info I’ve provided is accurate & complete

Initials

Thanks for submitting!