COVID-19 Self Reporting
YOU SHOULD ONLY COMPLETE THIS FORM IF YOU

    ➜ RECEIVED A POSITIVE TEST RESULT FOR COVID-19, OR

    ➜ CURRENTLY HAVE SYMPTOMS OF COVID-19.

Completing this form is voluntary. Information submitted using this form will be viewed by a limited number of College officials, and will not be shared with organizations outside of ECC. Collected data will be used to facilitate a healthy campus environment for our students, faculty, and staff.
Sign in to Google to save your progress. Learn more
To continue, please type ECC. *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Edgecombe Community College.

Does this form look suspicious? Report

Google Forms