COVID report form

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COVID report form

Please use this form to report if you think you might have be exposed or infected with COVID-19. All questions are optional in case you do not want to disclose health information. You do not have to tell us, but it will help the community to do so.

Email *

Name

Who is your PI?

Did you inform your PI?

Yes

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When did you notice symptoms of COVID?

YYYY

Did you get tested for COVID?

Yes

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When was the last time you were at SU Physics Department?

YYYY

Please list the rooms in the physics building you were visiting and how long you were there.

Please list any person you had contact with in the past week

If you think you have COVID-19, please quarantine for two weeks. If you need help getting food or supplies, please contact the physics department and we will coordinate someone to drop supplies off for you. If your test comes back positive, use your list to contact people to let them know they were exposed to you. Please also inform the department chair (jlross@syr.edu) and your PI.

Send me a copy of my responses.

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