COVID-19 Positive CaseReporting Form

Name*

First and Last Name

Bronco ID*

Email *

Phone #

CPP Affiliation

Select or enter value

Work/Class Location

For employees, please enter the work location, including office, dept. or facility

For students, please enter classrooms or facility

Last Day at CPP

Please enter the last date you were physically present at CPP prior to the positive test/diagnosis

Date of Positive COVID-19 test

Please enter the date you tested positive for COVID-19 (antigen testing) or received a formal diagnosis

Send me a copy of my responses