Reporting Covid-19 to Navajo Technical University
Please fill out the form if you or someone you know was exposed to COVID-19 on or off Navajo Technical University Campuses.

MANDATORY (Use the reporting process when you have:)
- Received confirmed COVID-19 diagnosis, based on your own positive test result or the test result of someone with whom you share a residence. (Please send your Test results to reportcovid@navajotech.edu)
- Concerns about any members of the Navajo Technical University community having or had COVID-19, when on or off campus.

For questions about Reporting Covid-19 please email reportcovid@navajotech.edu.

This data is collected by our COVID Reporting Team. Our team will contact you within 24 hours after receiving COVID report.

Sign in to Google to save your progress. Learn more
Full Name (Last and First Name) *
Student, Staff or Faculty *
Enter your email *
Contact Phone Number *
County of Residence *
Last date/time on campus *
MM
/
DD
/
YYYY
Identify buildings from when last on campus *
Date of COVID positive test result *
MM
/
DD
/
YYYY
Type of COVID test (if known) *
Date symptoms started
MM
/
DD
/
YYYY
Date of exposure to other COVID positive individual *
MM
/
DD
/
YYYY
Names of employees, visitors, students were you in contact with while on campus *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Navajo Technical University.

Does this form look suspicious? Report

Google Forms