COVID-19 self-assessment form

This form is used when the campus status is Orange or Red, according to the U.S. Center for Disease Controls’ scale for COVID-19 Community Spread Assessment Level. This form must be used by anyone who is planning to be on campus for any amount of time. The form needs to be completed each day that you intend to be on campus.

• Fever of 100.4℉ or higher
• Cough
• Shortness of breath
• Conjunctivitis (red eyes)
• Loss of smell or taste
• Severe headache
• Sore throat
• Chills and/or body aches
• GI symptoms including vomiting, diarrhea, or nausea
If you have questions or need assistance with the COVID-19 assessment process, please call Campus Patrol at (810) 989-5757.