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 potential 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.
Is there a possibility that you have been exposed to a confirmed case of COVID-19?
*
Yes
No
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