COVID Self-Report Form

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Please complete the following form.

A member of the Campus Safety Team will be contacting you to discuss the next steps and answer questions you may have about resources available to you.

Please remain quarantined at your residence until instructed otherwise by the Campus Safety Team.

Our goal is to ensure you are well so that you may return to normal day to day activities at RMC as quickly as possible.

If it is after business hours AND you are an on-campus student, please contact the Emergency On-Call Residence Life Staff at 406.238.SAFE.

Email *

First Name *

Last Name *

Cell Phone Number *

Status *

Student - Lives On-Campus

Student - Lives Off-Campus

Faculty

Staff

RMC Employment *

Full time employee

Part time employee

Student employee

Not employed by RMC

If Student Lives On-Campus which Residence Hall

Anderson

Jorgenson

Rimview

Widenhouse

Clear selection

Status *

I have tested positive for COVID-19

I am a confirmed contact of a COVID-19 positive case

Date of Positive Test or Last Contact with COVID-19 Positive Case *

YYYY

I am *

Showing symptoms of COVID-19

Symptom FREE

Hospitalized *

I have been hospitalized as a result of this report

I have NOT been hospitalized as a result of this report

I am required by a medical professional to quarantine *

Yes

If ordered by a medical professional to quarantine - date provided to end required quarantine

YYYY

Submit

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