COVID-19 Reporting Form for SDSURF Employees

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To ensure that we can provide support and resources to staff who are affected by COVID-19, SDSU Research Foundation (SDSURF) requests that that supervisors (or a designee) complete the form below for any employee who experiences symptoms of COVID-19, is exposed to COVID-19, or tests positive for COVID-19. This information will also assist SDSURF, SDSU, and public health officials with monitoring the incidence of cases occurring in our community.

SDSURF is committed to ensuring that your submission remains private and only utilized to provide support and resources. Your submission is not a substitute for medical advice; if you are in medical distress, please call 911.

Email *

Employee RedID:

Employee Full Name: *

Employee Email Address: *

Employee Best Contact Number: *

Project Name: *

This employee (choose one): *

Has been exposed to COVID-19 and is experiencing symptoms consistent with COVID-19

Has tested positive for COVID-19

This employee works (choose one): *

Remotely

On site

Both remotely and on site

Last date the employee was on any work location: *

YYYY

Please provide a description of the situation below: *

Is this employee currently self-isolating/self-quarantining away from SDSU and SDSURF locations? *

Yes

Unknown

Do you have reason to believe that this employee may have exposed other employees to COVID-19 in the workplace? *

Yes

Your Name: *

Your Role: *

Your Email Address: *

Submit

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