Illness Self-Report Form
Please complete the following form.
Once received you will be contacted by a member of the Student Life Team or the Office of Human Resources to answer questions you may have about resources available to you during your illness.
If it is after business hours AND you are an on-campus student, please contact the Emergency On-Call Residence Life Staff at 406.698.8777.
When a student or employee of RMC completes the Illness Report Form and contacts Riverstone Health or another local healthcare provider, it is important to ask the following questions regarding your care so that you may return to normal day to day activities at RMC as quickly as possible.
1. Should I be tested for COVID-19? If so, where may I be tested and when?
2. If I am tested, when should I expect to receive my results and how do I obtain them?
3. Should I isolate myself from others? If so, for what length of time?
4. How do I obtain documentation regarding my ability to return to work or school from your healthcare facility?
5. Please explain to me the steps involved in this process, so that I know what to expect as I work to return to normal activities.
First and Last Name
Cell Phone Number
Student - Lives On-Campus
Student - Lives Off-Campus
If Campus Visitor or Other please explain
RMC Athletic Program
I'm not part of RMC Athletics
Not Experiencing Symptoms BUT have been in contact (within 6 feet for 15 minutes or more) of someone with a confirmed positive COVID-19 test
Experiencing Symptoms AND have been in contact (within 6 feet for 15 minutes or more) of someone with a confirmed positive COVID-19 test
Experiencing Symptoms AND HAVE NOT been in contact (within 6 feet for 15 minutes or more) of someone with a confirmed positive COVID-19 test
Have tested positive for COVID-19
Tested for COVID-19
I was tested and test results were negative
I was tested and test results were postive
I have been tested but have not yet received results
I have not yet been tested
If tested - what date
Never submit passwords through Google Forms.
This form was created inside of Rocky Mountain College.