TCD COVID19 Student Notification Form

TCD COVID19 Student Notification Form

Please fill this form if you have COVID symptoms, exposure or a positive test.
Full Name*

First NameLast Name
When where you last physically present at TCD?

MonthDayYear
Date
Please select your program area.*
Do you have COVID19 symptoms? If yes, you must quarantine for 14 days or to attend school sooner, a healthcare provider’s note documenting the alternative diagnosis, or a negative COVID-19 test result should accompany a student or staff member returning to school with an alternative diagnosis after experiencing COVID-like symptoms. In addition, at a minimum, the individual must be fever-free for 24 hours without the use of fever-reducing medications (including OTC) and have had no diarrhea or vomiting in the previous 24 hours.
Symptoms may appear 2-14 days after exposure to the virus. People with these symptoms may have COVID-19: Fever or chills, Cough, Shortness of breath or difficulty breathing, Fatigue, Muscle or body aches, Headache, New loss of taste or smell, Sore throat, Congestion or runny nose, Nausea or vomiting, Diarrhea.
Date when symptoms started

MonthDayYear
Date
Quarantine End Date (+14 days, can be shorter if alternative diagnose is provided, or negative COVID-19 test result is provided)

MonthDayYear
Date
You must quarantine due to being exposed to COVID19 by:
1. Being within close contact with some one who has tested positive for COVID19 (14 Days),
2. If one of the household members is being evaluated for COVID-19, the rest of the house hold must be quarantined until an alternative diagnosis is made or negative result received (14 Days).
3. You are living with someone who has tested positive for COVID19 (14 Days)
4. You tested positive for COVID19 (10 Days with 24 hours without symptoms or the aide of medicine including over the counter).
If you answer yes to any of the listed reasons please click YES and enter the dates?
Individual who has had close contact (< 6 feet) for ≥15 minutes:
- Person with COVID-19 who has symptoms (in the period from 2 days before symptom onset until they meet criteria for discontinuing home isolation; can be laboratory-confirmed or a clinically compatible illness)
- Person who has tested positive for COVID-19 (laboratory confirmed) but has not had any symptoms (in the 2 days before the date of specimen collection until they meet criteria for discontinuing home isolation).
Date of Exposure / Quarantine Start Date

MonthDayYear
Date
Quarantine End Date

MonthDayYear
Date
Have you been tested for COVID19?
- If you test positive, know what protective steps to take to prevent others from getting sick.
- If you test negative, you probably were not infected at the time your sample was collected. The test result only means that you did not have COVID-19 at the time of testing. Continue to take steps to protect yourself.
Date of Test

MonthDayYear
Date
Are the results available?
Provide Test Result

Positive Test ResultNegative Test Result
This section is for the person submitting the form:
Name of Person Submitting the Form*

First NameLast Name
Email of the Person Submitting the Form*
example@example.com
Additional Notes
Hidden reply-to email
example@example.com
Should be Empty:

TCD COVID19 Student Notification Form

This section is for the person submitting the form: