K-12 COVID-19 Abbott BinaxNOW Testing Registration Form

K-12 COVID-19 Abbott BinaxNOW Testing Registration Form

BinaxNOW Testing Kits will arrive within approximately 7-10 business days to the address provided.

Date*

School Information

School District Name*

School Name*

School Address*

City*

Zip Code*

Student Enrollment for 2021-2022 School Year*

Staff Enrollment for 2021-2022 School Year*

School Testing Administrator Information

Name of School Testing Administrator*

The school testing administrator will be the person responsible for observing specimen collection, performing the Abbott BinaxNOW rapid-point-of-care antigen test, and logging test results.

Email of School Testing Administrator*

Phone Number of School Testing Administrator*

Person Completing Form Information

Name of Person Completing Form*

Position of Person Completing Form*

Email of Person Completing Form*

Phone Number of Person Completing Form*

Please check below next to each statement

Requirement for in-person instruction: I attest that the school listed above is currently serving students in limited or full in-person instruction. I understand that participation of the school listed above in future testing opportunities is not guaranteed.*

Training Attestation: I attest that the school testing administrator has read this guidance in full and has completed the Abbot BinaxNOW training modules.*

Consent Attestation: I attest that the school testing reporter and school testing administrator understand that testing may only be performed for students with consent on file and staff that have provided verbal consent.*

Testing Strategy Attestation: I attest that the school listed above will follow OHA K-12 testing guidelines and test only symptomatic and exposed students and staff. The school will not use the supplied Abbott BinaxNOW test kits to perform "screening" test on people without symptoms and no known exposure to COVID-19.*

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