Student Positive Case Reporting

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please complete this form any time you have tested positive for COVID-19.

CDC Recommendations:

When people get sick with a respiratory virus, the updated guidance recommends that they stay home and away from others.

The recommendations suggest returning to normal activities when, for at least 24 hours, symptoms are improving overall, and if a fever was present, it has been gone without use of a fever-reducing medication.

Once people resume normal activities, they are encouraged to take additional prevention strategies for the next 5 days to curb disease spread, such as taking more steps for cleaner air, enhancing hygiene practices, wearing a well-fitting mask, keeping a distance from others, and/or getting tested for respiratory viruses.

Upon completing this form, the Dean of Students Office will provide the appropriate Disrupted Attendance Notification to your faculty members. If you have concerns about completing this form, please contact the Dean of Students Office at (816) 271-4432 or deanofstudents@missouriwestern.edu

First Name *

Last Name *

G# *

Missouri Western Email Address *

Cell Phone Number *

Where are you living? *

On Campus

Off Campus

Tell us your situation: *

I have a confirmed case of Coronavirus, COVID-19

Other:

If you were tested, when did you get tested and where?

When can you return to class?
*

YYYY

Please check all that apply. *

I am an athlete (This does not include esports)

I have a mask

I have transportation to take myself to get tested or for medical appointments

I work on campus

Other:

Required

Which coach or supervisor needs to be notified?

Are you completing this form on behalf of a student? *

Yes

Clear form

Never submit passwords through Google Forms.

This form was created inside of Missouri Western State University. Report Abuse

Forms