Notification of a COVID-19 Incident

Background Information

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Your full name:

Your phone number:

Your email address:

Email address must be of a valid format.

Person Reported On

Information of person possibly exposed or testing positive for COVID-19

Full Name

Relationship to the University

CCU ID

Phone number

Email address

Questions

Please answer these brief questions.

What is the name of the department/office where the person being reported on works?(Required) This field is required.

Q1 - If the person being reported on is a University affiliate, can you provide additional information, i.e. employed by Ararmark, Barnes and Noble, etc.? This field is required.

Q3 - What is the status of the person being reported on?(Required)

Positive Test Result Symptomatic Close contact (within 6 feet of an infected person for a cumulative total of 15 minutes or more over a 24 hour period starting 48 hours before symptom onset or specimen collection which results in a positive test)

This field is required.

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

Background Information

Person Reported On

Questions

Supporting Documentation

Submission