Inquire Now

Health Self Reporting Form

Please fill out this questionnaire if you have any reason to believe you have been exposed to the COVID-19 virus, have been experiencing symptoms, or tested positive for COVID-19. A staff member will be in touch with you regarding next steps depending on your responses. 

If you have been exposed to the COVID 19 Virus, please respond to the following.  You will be contacted to discuss potential need to quarantine and either how to best assist you with continuation of your academic studies (for students) or work from home plans (employees.)

If you are experiencing symptoms of the COVID 19 Virus or have been diagnosed with the virus, please respond to the following.

(If you do not have a primary care provider in the area, call LaVista CHI clinic at 402-717-9500 and they will provide guidance, and if necessary, be prepared to meet any patient with COVID- 19 procedures.)

A staff member will call you to discuss how best to cover your work if you are a faculty or staff member or how best to assist you with your classes if you are a student.