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Self-Assessment

Though you probably filled out this form before returning to work on campus, you must complete this form again if circumstances change any of the answers you previously gave.

You'll need to complete the form again as soon as possible if you do any of the following after completing the form:

  • Travel out of state or out of the country
  • Travel commercially (on a bus, train, or plane)
  • Attend an activity where more than 50 people are present
  • Experience any of the following NEW symptoms:
    • fever (100.4°F or greater)
    • cough
    • shortness of breath or difficulty breathing
    • persistent pain or pressure in the chest
    • new confusion or inability to awaken
    • bluish lips or face
    • other flu-like symptoms
    • loss of taste
    • loss of smell
    • sore throat
    • gastrointestinal issues
  • Are diagnosed with or treated for COVID-19 symptoms
  • Come in close contact (within 6 feet, caring for someone, living with someone, sharing a space with someone, etc.) with a person confirmed or suspected of having COVID-19