Report a Positive Self-Test

Schenectady County residents can use this form to tell Schenectady County Public Health Services (SCPHS) about a POSITIVE COVID-19 self-test. The self-test must be authorized by the Food and Drug Administration (FDA). A list of authorized self-test can be found here.

Negative results from self tests do NOT need to be reported. Self-tests can NOT be used for release from quarantine.

This form should NOT be used to report results of a test obtained or performed at or through a doctor's office, clinic, hospital, laboratory, pharmacy, school, or any testing site or program operated by SCPHS.

After submitting this form please view the information at www.schenectadycounty.com/COVID19 and take the actions appropriate to your particular circumstances.

If additional information is needed, Schenectady County Public Health Services will contact you.

FIRST Name of Person with the positive self-test

First name of the person who self-tested positive with COVID19

LAST Name of Person with the positive self-test

Last name of person with the positive self test

Date of the Positive Test

Symptom onset date

If asymptomatic leave blank.

Birth date of the person with the positive self-test

Please enter the home address of the person with a positive self-test

Address

City/Town

State/Province

ZIP/Postal Code

10 digit Phone Number (no dashes)

Telephone number where you can be reached

Email Address

Email where you can be reached

Does the person with the positive self-test:

Live, Work, or provide services to people at congregate living facilities?

Attend or work at a preK-12 school

Work for a Health Care Facility

None of the above

Select the brand of self-test used

Who can we contact to get more information about the person with the positive test?

Name of the parent or guardian to contact

SCPHS is strongly committed to protecting personal information collected through this website against unauthorized access, use, or disclosure. Consequently, SCPHS limits employee access to personal information collected through this website to only those employees who need access to the information in the performance of their official duties. Employees who have access to this information follow appropriate procedures in connection with any disclosures of personal information.

SCPHS may collect or disclose personal information without consent if the collection or disclosure is: (1) necessary to perform the statutory duties of the SCPHS, or necessary for SCPHS to operate a program authorized by law, or authorized by state or federal statute or regulation; (2) made pursuant to a court order or by law; (3) for the purpose of validating the identity of the user; or (4) of information to be used solely for statistical purposes that is in a form that cannot be used to identify any particular person.