COVID-19 (Coronavirus) Contact/Exposure Report Form
Person Reporting Incident
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If you tested positive, please submit date of positive test.
Enter a location

* If you have tested positive, please let anyone who you had close contact with (spent more than 15 minutes within six feet) that you have tested positive. This applies to anyone who you had contact with since two days before you tested positive.

Symptoms and Actions Taken

Please provide information regarding when you or the individual may have been exposed, symptoms you/they are currently experiencing, actions taken, and if any assistance is needed from Galveston College.
Dates believed to have been in contact with someone affected by COVID-19:
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Dates believed to have been in contact with someone affected by COVID-19
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Dates believed to have been in contact with someone affected by COVID-19
For information about what to do if you think you are sick or to protect yourself, visit
www.cdc.gov/coronavirus.

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