Coronavirus Exposure, Testing, and Confirmed Diagnosis
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This form is for students and employees from the University of Evansville and Harlaxton College to complete.
In an effort to educate our campus community about possible exposures to the Coronavirus (COVID-19), please provide the following information regarding:
1) Any exposure you may have had to COVID-19
2) If you are currently waiting for COVID-19 test results
2) If you have a confirmed diagnosis for COVID-19
1.
If you have travelled beyond Indiana recently, where did you go and on what dates?
2.
Have you been notified that you have been identifuied as being a close contact or have been exposed to someone who has a confirmed case of COVID-19?
*
*Selecting "Yes" will bring you to a page that asks about the nature of your contact and your level of exposure. It will also ask if you are awaiting COVID-19 test results.
Yes
No
A Close Contact: Anyone who was within six feet of a diagnosed person – within the last 48 hours of that person’s diagnosis or onset of symptoms – for at least 15 minutes with or without a mask.
Exposed: Anyone who has been in contact with a person who has potentially been diagnosed with COVID-19 within the last 48 hours.
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