Student Self-Report: COVID Testing, Positive Results, and Exposure
Student Self-Report: COVID Testing, Positive Results, and Exposure
Please use this form to report if:
you have tested positive for COVID-19
,
you
have been or are getting tested 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:
Reporting someone who has been or is going to get tested for COVID-19
Reporting someone who has tested positive for COVID-19
Reporting someone who has been in close contact with a COVID-positive individual
Contact Information for Person Completing Form
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.
*