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 or Employee or Other?*

Student

Employee

On-campus Volunteer/Vendor or Other

Hartnell ID NumberMust be 7 numbers, including zeros

Name*First and Last Name

Date Last on Campus*Provide the date you were last physically on campus

Date of Exposure (if known)If unknown or not applicable, go to next question

Date Symptoms Began (if any)Common symptoms: Sore or scratchy throat, runny nose, headache, fatigue

Date Positive Test Was Taken (if tested)This is the date the test was taken, not the date results received

Type of Test (if taken)

During the Two Days Before symptoms began OR testing positive with no symptoms, you:If needed, provide more clarification in the "Describe COVID Incident" field below

Describe Covid Incident 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*The best way to reach you for more information, if needed

Report Covid Incident

Please report your COVID-19 incident by completing the information below.(Note: Required fields are denoted by *)

Please report your COVID-19 incident by completing the information below.
(Note: Required fields are denoted by *)