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COVID-19 Exposure Health and Safety Intake Form

This form ONLY has to be filled out if you have been exposed to someone with COVID-19 or have been tested and confirmed positive for COVID-19. You do not need to fill out this form if you have not been to campus or any other QCC location within the past 14 days.

Thank you for taking the time to report. We wish you a speedy recovery.

If a healthcare provider or medical professional has confirmed the Coronavirus/COVID-19 diagnosis, please do NOT to come to campus.

If the diagnosis is suspected, but not yet confirmed, please call your healthcare provider and call the college again when the results are in. DO NOT come to campus until you have received further guidance from a contact tracer.      

For Pfizer and Moderna, please fill out both vaccination dates if you have received them. For Johnson & Johnson, please fill out the first vaccination date only.

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