About
MARTA

Employee Intake Form

Form Completed By

First Name*
Last Name*
Email*

Employee Information

Employee ID*
First Name*
Last Name*
Email*
Phone Number*
Alternate Phone
County
Where is employee currently residing? (City, State)
Where has the employee been working? (ex: HQ2, Route 5, Five Points, etc.)*

Job Position*
Department*
Office*
Location*
Supervisor Name*
Supervisor Phone*
Information received from Employee*
Employee first started to feel ill
Employee was last onsite at work*
MARTA was first informed of employee having a positive COVID-19 test (if applicable) date

Is the employee working remotely?