Fillable COVID 19 Exposure Reporting Form For Emergency Services Organizations (Broome County)

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COVID 19 Exposure Reporting Form For Emergency Services Organizations (Broome County)

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The COVID 19 Exposure Reporting Form For Emergency Services Organizations (Broome County) form is 1 page long and contains:

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Country of origin: US
File type: PDF

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Agency infection control
officer notified:
Contact Cell:
Number exposed from
your agency:
Are they under self-
isolation:
Incident #:
Location:
Agency Contact:
Broome County COVID-19 Exposure Reporting Form
Agency Name:
Exposure Date:
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COVID 19 Exposure Reporting Form For Emergency Services Organizations (Broome County)

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Completed 17 July 2020

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