COVID-19 Positive or Suspected Case Report

This form is for members of the Spoon River College community (students, faculty, and staff) to report confirmed or suspected cases of COVID-19.

You are strongly encouraged to fill out this form if any of the following apply to you:

• You have been diagnosed with COVID-19
• You have been referred for testing or told by a health care provider that you have a suspected case of COVID-19
• You have come into close contact (closer than 6’ for more than 15 minutes) with someone who has a confirmed case of COVID-19
• You live with someone who had or currently has a confirmed or suspected case of COVID-19
• You have been told to self-isolate or quarantine by a medical provider or public health authority
• You are a faculty or staff member and a student reported to you that they meet any of the criteria above

Any students, faculty members, and/or staff who feel they may have Novel Coronavirus Disease 2019 (COVID-19), or may have been exposed to someone who has COVID-19, should consult their primary care physician. If your symptoms are severe, go now to a clinic or hospital or call 9-1-1. Click here for a complete list of symptoms, and additional information on seeking medical attention, from the Centers for Disease Control and Prevention (CDC), COVID-19 symptoms.

Please note: The College may be obligated to notify local public health authorities of any positive cases of COVID-19 of which it is aware.

Following a COVID-19 related absence, see how to return by viewing our Return to School/Work Flowchart.

Upon receipt of this form, College staff will follow-up with the individual referred in order to check in with them, gather additional information to assist with contact tracing, assess their needs, and communicate appropriate return to school/work protocols.

 COVID-19 Positive or Suspected Case Form








Bystander Reporting
Please fill out as much information as you can about the student to whom which this report concerns.




Additional Questions







Select a date from the calendar.




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If no, please attach picture of vaccination card.: 
  

If you will miss class or work, please contact your faculty members and/or your supervisor
Supporting Documentation
If you have received documentation from a local health official advising you to quarantine or isolate, please attach that information here. In cases where you are requesting accommodations due to illness, please include proper medical documentation affirming diagnosis.Supporting documentation attachment 1: 
  
Supporting documentation attachment 2: 
  
Supporting documentation attachment 3: 
  

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