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COVID-19 Reporting

Please complete the form below. Required fields marked with an asterisk *

Contact Information

First Name*

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Last Name*

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Position*

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Supervisor*

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Phone Number*

Number Required

Close Contact

Close contact is defined as being within 6 feet of another individual for 15 minutes or more over a 24-hour period with or without masks.

Please list the staff/faculty members you have had recent close contact with:*

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Please list the students you have had recent close contact with:*

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Confirmation Email

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