COVID Incident Report - Facility Side Name of person completing this form* typically recruiter/account managerDate form completed* Name and title of client/facility contact that is confirming facility-side information*Complete all fields belowDate & Time of report to Facility by Anders Group employee* Name of facility contact reported to and their title:*What method of communication was used? i.e. text, in person, email, etc.* Details of possible COVID-19 exposure:*Is the candidate being tested for COVID or anything else?*Was there adequate resources of PPE available for the traveler to use?*What are the next steps for how and when the candidate will be cleared to return to work?*Upload DocumentsMax. file size: 50 MB.Upload any related documents, if applicableCandidate Recruiter Name* Client Recruiter Name* Δ