Student COVID-19 Report Checklist Form

The information provided below is collected for assessment by the JCC COVID-19 Emergency Response Team
and is treated as confidential, shared on an as-needed basis, only.

* 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.

Please include whether your symptoms started in the morning, afternoon, or evening.

Please email a copy of your vaccine record to

If you selected YES:

Please email a copy of your test results to, displaying your name, the test date, and testing site/location.

If you selected NO:

Prepare to get tested for COVID-19 at least 5 days after any onset of symptoms or exposure to another COVID-positive person.

IMPORTANT: It is highly recommended that you keep in communication with your instructors!

NOTE: The Johnston County Public Health Department defines “close contact” as being less than 6 feet from another person for a cumulative time of 15 minutes or more, regardless of wearing masks.

Include any additional comments that you would like to add to provide clarity regarding the situation, to include
vaccine details.

Please also provide the best phone number you can be reached at, if needed. If you need more space,
include additional details within an email to or

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.