Travel Smart Reporting Form - DO NOT COMPLETE
Although La Crosse County does not yet have any cases as of 3 PM on 3/17/2020, Wisconsin is experiencing community transmission of COVID-19. For this reason, effective immediately, we will no longer be contacting those who have traveled because travel risk is now uniform.

We recommend staying home.

Please do not complete the form. If you have recently traveled, especially to a place with widespread community transmission of COVID-19, you should monitor your symptoms (fever, cough, tiredness, shortness of breath or difficulty breathing, or sore throat) for 14 days following your return and report to your healthcare provider if you develop symptoms.

Testing is being reserved for those with higher risk as determined by state and federal guidelines due to a shortage of testing supplies. That said, you do not need to have a test to know what to do. If you develop symptoms, stay home, take care of yourself, and seek medical care if you need it.

For additional information, please see: http://lacrossecounty.org/covid19
Are you reporting travel for yourself, someone else or both? *
Which of the following countries will be visited or were visited? Select all that apply. *
Required
On which dates did this travel take place?
Your answer
What is your name, or the name of the individual(s) who traveled to these locations in the past 14 days? *
Your answer
What is YOUR phone number? Please include area code. *
Your answer
If you are reporting travel for someone else and have the phone number of the traveler(s), please share their phone number(s) here.
Your answer
Do you have any of the following symptoms: cough, abnormal tiredness, fever (100.4 F or greater), difficulty breathing or sore throat?
Does anyone else who traveled have any of the following symptoms: cough, abnormal tiredness, fever (100.4 F or greater), difficulty breathing or sore throat?
Are any of the travelers employed by a healthcare institution?
IF YES: What healthcare institution do you/this individual work in?
Your answer
OPTIONAL: If you are out of the country or would like to receive information via email, feel free to share your email address with us.
Your answer
If you have any additional questions, comments or concerns, please share them here.
Your answer
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