Student COVID-19 Report Checklist Form

The information provided below is treated as confidential and shared on an as-needed basis.

If you are waiting on information to complete this checklist, please go ahead and submit what you know now, make a note at the bottom of the page, and plan on following up with any updates, to include test results.

* Indicates Required Field (failure to answer all required fields may result in a failed form submission)
Type "N/A" in any fields that do not apply to your situation.

Initial Process for a Student Case:

  1. Student reports exposure, symptoms, and/or positive test results to instructor.
  2. Instructor will send the “Student Checklist” to the student.
  3. As soon as possible, student answers all the questions on this checklist and submits it to their instructor.
  4. Student refers to the CDC for recommendations based on their situation at:   
  5. Instructor follows up with the student on next-steps, as-needed.
  6. Contact JCC Safety at for questions.

Note *(Contacting tracing will only occur if the county is designated as high risk)

If you are experiencing symptoms please leave campus and follow CDC guidelines regarding your return date.

"Close contact” is being less than 6 feet from another person for a cumulative time of 15 minutes or more in over a 24-hour period.

REMINDER: Before you click "Submit" make sure all required (*) fields have been answered. 
Type "N/A" in any fields that do not apply to your situation.

Be prepared to submit a copy of your test result and proof of vaccination (if applicable). If neither are readily available,
please follow up as soon as possible once results are known and/or documentation is located.

Do not schedule a test any sooner than five (5) days after onset of symptoms or exposure to COVID-19.