NMT COVID-19 Case Reporting Form
It is important that supervisors and instructors actively monitor the health and well-being of those under their direct supervision. You are required to use this form should an individual (student, staff, or faculty) disclose to you that they have tested positive for COVID-19. All CV19 case positive NMT students and employees must be reported even if they are distance learning or mainly work remotely and do not physically come to campus. Please contact Steph Plant if you have any questions regarding reporting at 575-835-5548 or
(1) The IMMEDIATE reporting of a COVID-19 incident is both required and essential to protecting our campus community.
(2) This form is intended for supervisor/instructor use only. The completion of this form should not be delegated to other supervisors or other employees.
(3) Protecting the confidentiality of individuals is important and this form requires you to make every effort to ensure this for those in your reporting line. The contents of this form will be routed to the appropriate points of contact in the Office of the President, Office of Student Life or Office of Academic Affairs for further action as necessary. All NMT division vice presidents will also be notified of this incident for their information and action.
GOVERNING POLICIES & INFORMATION
(1) COVID-19 Decision Trees
(2) COVID-19 Information Page
(3) NMT Resilient Reopening Plan
I acknowledge the information provided in this form is confidential and I will not share or disclose any information. I have read the guidance provided above and understand my responsibilities.
Never submit passwords through Google Forms.
This form was created inside of New Mexico Tech.