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Report Covid Incident
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Campus Safety and Security
Emergency Information
Report Covid Incident
Please report your COVID-19 incident by completing the information below.
(Note: Required fields are denoted by *)
If you see this don't fill out this input box.
Student, Employee, or Other?
*
Student
Employee
On-campus Volunteer, Vendor, or Other
Hartnell ID Number
Must be 7 numbers, including zeros
First & Last Name
*
First and Last Name
Last Date and Time on Campus
*
Provide the date you were last physically on campus
Date of Exposure (if any known)
If unknown or not applicable, go to next question
Date Symptoms Began (if experiencing any)
Common symptoms: Sore or scratchy throat, runny nose, headache, fatigue
Date Positive Test Was Taken (if applicable)
This is the date the test was taken, not the date results received
Type of Test Taken (if applicable )
Please Select
Antigen / Rapid / At-home
PCR / Lab
During the Two Days before symptoms began or testing positive with no symptoms:
Please Select
N/A: I do not have symptoms or a positive test result
I attended all scheduled classes/meetings/activities on campus
I attended some but not all scheduled classes/meetings/activities on campus
I Did NOT attend any classes/meetings/activities on campus
Please also provide clarification in the "Describe COVID Incident" field below
Describe COVID-19 Incident (provide any additional detail)
Provide more info: Specific class/meeting/activity attended, which campus location, and names of people possible exposed/involved
Your Email Address
Your Phone Number
Preferred Method to Contact You
*
Please Select
email
telephone
The best way to reach you for more information, if needed
Form UUID
Site Name
Submit Report
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