COVID-19 Reporting Form

COVID-19 Reporting Form

First and Last Name*

Connection to WPU*

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Phone Number*

Email Address*

Please add an email address you check frequently as we will be contacting you at the address you provide. Please also check your spam filters in case our messages are filtered out of your inbox.

I live:*

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PGS or Trad

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Athlete?*

Select or enter value

I am reporting that:*

Exposure is defined as within 6 feet for 15 or more minutes of someone who tested positive.

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I have been fully vaccinated*

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I have received a booster shot*

Yes

No

The last day I was on campus was:*

(If symptomatic) The first day I experienced symptoms was:

Day of known exposure by close contact (If known)

Date of positive test (If you have been tested)

Send me a copy of my responses

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