Employee | Health Services COVID-19 Symptom Report

ETBU email address

Phone

Are you a graduate assistant?

Is a member of your household also employed at ETBU?

Please add the household member's name.

What date were you exposed?

Who exposed you to COVID?

Who is your supervisor?

Select One

What date did your symptoms start?

What date did you have your test?

Where did you have your test?

What date did your symptoms start?

Have you been vaccinated for Covid-19?

What date did you receive the vaccine?

Please send proof of documentation that you received the vaccine to healthservices@etbu.edu.