In response to Governor DeWine’s guidance and recommendations to Ohio Public Colleges regarding the COVID-19 virus in Ohio, WSCC is asking students and employees who have traveled on a cruise ship or have returned from a country at a Level 3 Travel Health Notice to contact their physician to be screened for the virus or stay home for a period of 14 days from the time they left the area at risk and practice social distancing. Please use this form to let WSCC know about your personal travel or exposure to COVID-19.
to access high-risk travel destinations.
Personal vacations and/or personal in-state or out-of-state travel are not limited or controlled by WSCC, but we will ask anyone who travels outside of their normal area to check in with the local health department before returning to campus.
Thank you for assisting us in fighting COVID-19.
1. First Name
2. Last Name
3. Cell Phone
4. Employee/Student Status
5. Travel Risk/Exposure
Level 3 country
Area with known COVID-19 cases
Exposure to someone with COVID-19
6. Please list anything else we should know about the travel indicated (include destination city, description, and beginning, and ending dates)
7. Please provide detail about your current status.
I have self-quarantined for 14-days from exposure.
I have been screened by my physician and tested negative. (please forward documentation from your physician to
Never submit passwords through Google Forms.
This form was created inside of Washington State Community College.