Student Self-Report: COVID Testing, Positive Results, and Exposure

Please use this form to report if:

you have tested positive for COVID-19, or
you have been in close contact with a COVID-positive individual.

If you are feeling symptomatic, please contact the Student Health Center at 904-256-8080 or contact your personal healthcare provider. Do not come to campus, and do not report to in-person class.

Are you reporting for yourself or another person?

Are you reporting for yourself or another person? Self Someone else
Please indicate the reason you are filling out this form:

Please indicate the reason you are filling out this form: I have been in close contact with a COVID-positive individual I have tested positive for COVID-19
Contact Information
Your Name Your Name * First Last
Your Email *
Your JU ID# *
Your Phone Your Phone * - ### - ### ####
Do you currently live on campus? *

Do you currently live on campus? Yes No
When were you last on campus? When were you last on campus? * / MM / DD YYYY
Contact Information for Person Who is Ill or Has Been Exposed
Their Name Their Name First Last
Their Email
Their JU ID#
Their Phone Their Phone - ### - ### ####
To the best of your knowledge, do they currently live on campus?

To the best of your knowledge, do they currently live on campus? Yes No I don't know
To the best of your knowledge, when were they last on campus? To the best of your knowledge, when were they last on campus? / MM / DD YYYY
Report
Reason for Report. Please provide a brief description of your travel, exposure, or illness. *

Student Self-Report: COVID Testing, Positive Results, and Exposure

Student Self-Report: COVID Testing, Positive Results, and Exposure

Contact Information

Contact Information for Person Who is Ill or Has Been Exposed

Report