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COVID-19 Exposure Health and Safety Intake Form

Faculty, staff, or students who are staying home due to symptoms, concerns, or diagnoses of COVID-19 and have been exposed to Covid-19 should complete this confidential health and safety intake form.

If you test positive for COVID-19 by either rapid or PCR test, please DO NOT come to campus.

Are you experiencing symptoms? When did they start?
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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