COVID Self-Reporting Form
You should complete this form if you are aware that you:
- Have been tested for COVID-19, with or without symptoms
- Have tested positive for COVID-19 or have been given a diagnosis of presumed positive by a health professional
- Have symptoms, but not yet tested positive
- Have had a CLOSE contact with an individual who has been tested and diagnosed with COVID-19
In alignment with the Centers for Disease Control's definition of CLOSE contact, reporting is necessary if you are someone who was within 6 feet of an infected person for a cumulative total of 15 minutes or more over a 24-hour period starting from 2 days before illness onset (or, for asymptomatic patients, 2 days prior to test specimen collection) until the time the patient is isolated.
Your identity will not be disclosed to anyone other than SIUE employees responsible for maintaining your health and safety, or Health Department officials as required. You may voluntarily share your information with whomever you choose.