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COVID-19: Reporting of Exposure, Symptoms, or Positive Test Results


This form should be used by students and employees (to include contractors and vendors) who are reporting that they have received a positive test result for the coronavirus, are experiencing symptoms of the virus, or have been exposed to a person who has symptoms or a positive test result for COVID-19. If you are not a student or employee, please use the CSU GUEST reporting form link here.

As of January 3, 2022 Columbus State University is following the updated Georgia Department of Public Health Covid 19 guidelines.  A link to these guidelines can be found here

You may be completing this online form yourself or talking to a member of the CSU COVID-19 Response Team. Whatever your circumstances, the University wants to help direct you to the proper resources for your health concerns, ensure that you receive the appropriate educational or employment accommodations, as needed, and protect our campus community.

Please understand that in the process of completing this self-reporting form or while speaking to a COVID-19 Response Team member, Columbus State University and its employees are not providing medical advice. You should check with your primary medical provider for question or concerns specifically related to your health.


Once your form has been submitted, a member of the Covid Response Team will follow up with you.

Background Information

In conjunction with the University System of Georgia, Columbus State University has partnered with the Georgia Department of Public Health for testing, notification, and contact tracing.


Unless you give permission, your name will not be revealed to those you came in contact with, even if they ask.

 
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The name of the person entering the information into the online form
Email address must be of a valid format.
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CSU emails for f/s/s; Contractors/Vendors should use their preferred account
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Please list yourself
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The resident hall you live in OR location of your office on campus
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Room number

INVOLVED PARTIES

A. Please enter your information below. (If you are the reporting partying and also the involved party, please fill out information in both spots.)


B. Please add the names of campus community members that you have had close contact with according to the definition of the Department of Public Health. Click on the "Add another party" button in the grey box to add these names. For additional information that may be helpful, see question #4 below, "QUESTIONS ASSOCIATED WITH OTHERS HAVING BEEN EXPOSED TO YOU" for clarification.

Close contact includes:


* Living with or caring for a sick person with COVID-19;


* Being within 6 feet of a sick person with COVID-19 for about 15 minutes (no matter whether a mask was worn or not); OR,


* Being in direct contact with secretions from a sick person with COVID-19 (e.g., being coughed on, kissing, sharing utensils, etc.).

 

Involved party 1

Questions

In the following questions we would like to gather more information about your illness and your activities after you became sick with or exposed to COVID-19 to help stop the spread.

QUESTIONS ASSOCIATED WITH YOUR SYMPTOMS 1. Are you currently experiencing symptoms of Covid-19?(Required)
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If you are experiencing or previously experienced symptoms, please check all that apply or applied:
You must make at least one selection.
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Please know that if you are experiencing COVID-19 related symptoms, you should not come to campus while you are sick. If you are an employee, you should also notify your supervisor in addition to completing this form. If you are a non-resident student and need additional information or assistance, contact the Dean of Students (706-507-8730; DOS@columbusstate.edu). If you are a resident student and need additional information or assistance, contact the Director of Residence Life (706-507-8710; reslife@columbusstate.edu). You should notify the University if you test positive for COVID-19. * Seek medical care if symptoms become severe. Severe symptoms include trouble breathing, persistent pain or pressure in the chest, confusion, inability to wake or stay awake, or bluish lips or face. * Seek medical care if symptoms become severe. Severe symptoms include trouble breathing, persistent pain or pressure in the chest, confusion, inability to wake or stay awake, or bluish lips or face. After a positive confirmation of COVID-19, a case investigator from the health department might call you to check-in on your health, discuss who you’ve been in contact with, and ask you to stay at home to self-isolate.(Required)
You must make at least one selection.
QUESTIONS ASSOCIATED WITH YOUR COVID-19 TEST RESULTS 2. Have you received notice of a positive COVID-19 test?(Required)
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Please know that if you received a positive COVID-19 test result, you should not come to campus.(Required)
You must make at least one selection.
QUESTIONS ASSOCIATED WITH YOUR EXPOSURE TO OTHERS 3. Have you been exposed to someone sick with COVID-19 or test positive for COVID-19, as described by the Georgia Department of Public Health, here below? You generally need to be in close contact with a sick person to get infected. Close contact includes: * Living with or caring for a sick person with COVID-19; * Being within 6 feet of a sick person with COVID-19 for a cumulative of 15 minutes or more within a 24 hour period, (no matter whether a mask was worn or not); OR, * Being in direct contact with secretions from a sick person with COVID-19 (e.g., being coughed on, kissing, sharing utensils, etc.).(Required)
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Please know that if you answered yes to being exposed to COVID-19, you should not come to campus. You should self-isolate and make the appropriate notifications to the Dean of Students, Director of Residence Life, or your supervisor, as noted above.(Required)
You must make at least one selection.
QUESTIONS ASSOCIATED WITH OTHERS THAT MAY HAVE BEEN EXPOSED TO YOU (for contact tracing purposes) 4. Have others been in close contact with you 48 hours before your symptom onset OR your date of COVID-19 testing? NOTE: The Georgia Department of Public Health describes Close Contact to generally mean you were: * Living with or caring for a sick person with COVID-19; * Being within 6 feet of a sick person with COVID-19 for a cumulative of 15 minutes or more within a 24 hour period, (no matter whether a mask was worn or not); OR, * Being in direct contact with secretions from a sick person with COVID-19 (e.g., being coughed on, kissing, sharing utensils, etc.). If you have not already done so, please list the names of any close contacts for campus community members in the section near the top of this form labeled Involved Parties.(Required)
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EMPLOYMENT ON CAMPUS 5. Do you work on campus? Please understand that if you are asked to self-quarantine you may be able to continue working remotely.(Required)
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GENERAL INFORMATION 6. We encourage you to notify members of your household and others you may have been in close contact with 2 days prior to the onset of symptoms, receiving a positive test for COVID, or you having been exposed to an individual with a positive test or one who is symptomatic. Unless you give permission, your name will not be revealed to those you came in contact with, even if they ask. Would you allow members of the COVID-19 response team to give your name when contacting those who fit the description of a Close Contact? Please do not feel any pressure to say yes.(Required)
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VACCINATION STATUS Any vaccination information provided will be used only by the Covid Response Team for assessing and providing the most accurate directions to you, and will not be used for other record-keeping purposes. 7. Have you received a Covid Vaccination?(Required)
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If you have received a vaccination, which brand did you receive? If available, please upload a copy or screenshot of vaccination card in Supporting Documentation portion of this form.
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If you cannot find your vaccination card or do not know the dates of your vaccinations, and have gotten your vaccinations in Georgia, do you give the Covid Response team permission to look up your dates of vaccination?
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This is a very stressful situation. Thank you for taking time to help the University help you and protect our campus community.(Required)
You must make at least one selection.
YOU MAY BE CONTACTED BY A MEMBER OF THE UNIVERSITY COVID RESPONSE TEAM A member of the CSU COVID-19 Response Team will follow up with you about your case, to include working with you to determine the appropriate date for your return to campus.(Required)
You must make at least one selection.

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission