COVID-19 Symptoms/Illness Reporting Form
Please use this form if you are experiencing symptoms, have had a positive COVID19 test result, or have been in close contact with someone who is sick.

If you are sick: If you just started to have symptoms, want to know if you need an official screening appointment, have already been pre-screened and/or screened by the infectious control teams in your local area, or if you have already been tested for COVID-19, then you should begin isolation and seek consultation with your provider by phone or, if necessary, in person.

If you have been in close contact with someone who is sick: If you are living with someone who is sick or if you have been notified that someone you worked with or spent time with in the past 2 weeks has been given the diagnosis of presumed COVID-19, or if you were in a location on the same day as someone identified as having a presumed or confirmed case of COVID-19, then you are considered a close contact and should begin quarantine.

This information will be held in high confidence and will allow your supervisor to know your situation and when you are cleared to return to campus. For students, this will help the seminary to assist with support.

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電子郵件 *
What is your name? *
What is your role at Calvin Seminary? *
What's your cell phone number (so we can communicate easily with you)? *
What is your current situation as relates to COVID-19? *
If you have received a Positive COVID19 test result, please tell us to the best of your ability with whom you have been in close proximity at Calvin Seminary (provide a name and contact information).
Are you under isolation/quarantine? *
If under isolation or quarantine, when did your isolation/quarantine start ?
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If under isolation or quarantine, when is your isolation/quarantine scheduled to end?
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Any additional information?
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