COVID-19 Positive Case Report

Your full name:

Your position/title:

Your phone number:

Your email address:

Email address must be of a valid format.

Location of incident(Required):

This field is required.

Specific location:

Please fill in as much information as you can, so that the Contact Tracing Team can respond in a timely manner. If you are self-reporting, please fill in this information even if it is repeated from the section above.

Name of Person who Tested Positive for COVID-19

Select Role

ID Number

Best phone number to reach you

Best email to reach you

What was the date that the person tested positive or started experiencing symptoms?(Required)

This field is required.

What is the last date that the person who tested positive was at any CCSF campus/location/site?(Required)

This field is required.

Was the person who tested positive at any CCSF campus/location/site within 48 hours of testing positive?(Required) This field is required.

Please tell us the names and provide contact information of anyone you had close contact (exposure for 15 minutes or more without a mask) on campus:(Required) This field is required.

Email me a copy of this report

Submission