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NEEHU 15 COVID Self Report Form
Use this form to report a positive test or symptoms suspicious for COVID-19. Please remain in your hotel room and do not enter conference space if you are not feeling well.

We will share self-reported information with other attendees to help them identify potential exposures. We will not share your name unless you explicitly allow it.
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Symptoms of COVID-19
Fever/chills, cough, shortness of breath/difficulty breathing, fatigue, muscle/body aches, headache, loss of taste or smell, sore throat, nasal congestion or runny nose, nausea, vomiting, and/or diarrhea.

Please seek emergency medical attention if you have having severe shortness of breath, difficulty breathing, chest pain, or any other symptoms that are concerning to you.
Email Address *
We might email you for verification of details or to ask clarifying questions. We will not disclose it to any event attendees.
NEEHU Badge Name *
This will not be shared with event attendees unless you explicitly consent.
Cell Phone Number *
We might text or call to verify details or ask clarifying questions if we are not able to contact you by e-mail. This will not be disclosed to any event attendees.
Do you consent to our sharing your scene name with the conference to facilitate contact tracing? Please type "yes" or "no" below.
This is completely voluntary and we will remove anyone from the event who harasses you
What is your COVID-19 vaccination status?
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What prompted you to self report?
It would be very useful to us to know if you have had a positive test and what kind (IE PCR test, rapid antigen, etc), what symptoms you are having, etc.
What classes/volunteer shifts/meals with others did you attend during the conference?
Thank you for self-reporting! We know it isn't easy, and we appreciate your honesty and bravery. We hope you are feeling better soon!
As a small thanks and to show appreciation for you taking action that you know will lead to missing the rest of the in-person con, we would like to offer you free registration at next year's event.
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