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







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If you will miss class or work, please contact your faculty members and/or your supervisor
Supporting Documentation
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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