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https://www.mcneese.edu/coronavirus/self-reporting-form/
https://www.mcneese.edu/coronavirus/self-reporting-form/
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McNeese State University
>
Coronavirus (COVID-19)
>
Self Reporting Form
Coronavirus (COVID-19)
FAQs
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Return to Campus
Self Reporting Form
Self Reporting Form
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Your Information
Tell us about yourself?
*
Select One
Student
Faculty
Staff
Banner ID#
*
Last Name
*
First Name
*
McNeese Email Address
*
Phone Number
*
Please Answer The Following
Do you have Symptoms?
*
Yes
No
I Have Symptoms (Check all that Apply)
From the CDC: People with COVID-19 have had a wide range of symptoms reported – ranging from mild symptoms to severe illness. Symptoms may appear 2-14 days after exposure to the virus. People with these symptoms may have COVID-19:
Fever or chills
Fever of 100.4 or higher
Cough
Shortness of breath or difficulty breathing
Fatigue
Muscle or body aches
Headache
New loss of taste or smell
Sore throat
Congestion or runny nose
Nausea or vomiting
Diarrhea
Date When Symptoms Started.
*
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I have received a positive test result
Date of COVID-19 test
Date Format: MM slash DD slash YYYY
Date you received the positive result
Date Format: MM slash DD slash YYYY
I have been exposed to COVID-19
Date you were exposed
Date Format: MM slash DD slash YYYY
Describe how you were exposed
Exposure is defined as: Someone who was within 6 feet of an infected person for at least 15 minutes starting from 2 days before illness onset (or, for asymptomatic patients, 2 days prior to specimen collection) until the time the patient is isolated.
Contact Tracing
*
Were you in
close contact*
with student, faculty or staff members for the previous 48 hours?
Close contact:
Someone who was within 6 feet of an infected person for at least 15 minutes starting from 2 days before illness onset (or, for asymptomatic patients, 2 days prior to specimen collection) until the time the patient is isolated.
Yes
No
Contact Tracing Names
*
It is important that we reach out to these individuals to see if they are experiencing symptoms. Please list all individuals that you can remember.
Names of Person
Phone Number
Final Questions
Are you in a Clinical Rotation?
*
Applies to College of Nursing and Health Professions students.
Yes
No
Clinical Rotation Continued
*
Clinical Instructor
Your Major
Are You a Student Athlete?
*
- Select One -
Yes
No
Which Athletic Program(s)?
Football
Baseball
Men's Basketball
Women's Basketball
Men's Cross Country
Women's Cross Country
Men's Golf
Women's Golf
Men's Track and Field
Women's Track and Field
Soccer
Softball
Tennis
Volleyball
Where are you working?
On Campus
Off Campus
Current Housing Arrangements
On Campus
Off Campus
Do you have a job on campus?
Select One
Yes
No
If YES, name of supervisor
A representative from Student Health Services will be in contact within 24hrs of your submission.
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