COVID-19 Intake Report


The purpose of this report is to connect affected individuals with information and resources, support our campus response, and minimize spread of the virus to other community members. If you prefer an alternate means of reporting, you may call the UHS support line at (410) 455-2542.


Reporter's Personal Info
*First Name:
*Last Name:
*Phone:
*Email:
*Primary Role:
*Other Role:

Reporter's Status
Select one of the following that best describes your status:



Status Information
Provide the actual or approximate date you were tested:

*Have you been on campus within two weeks of this test date?:
Provide the actual or approximate date you were most recently on campus:

Provide the actual or approximate date you received confirmation of a positive test result:

Provide the actual or approximate date you noticed symptoms:

*Have you been on campus within two weeks of developing symptoms?:
Provide the actual or approximate date you were most recently on campus:

Provide the actual or approximate date your close contact was tested:

*Have you been on campus within two weeks of this test date?:
Provide the actual or approximate date you were most recently on campus:

Provide the actual or approximate date your close contact received confirmation of a positive test result:
Provide the actual or approximate date your close contact noticed symptoms:

*Have you been on campus within two weeks of your close contact developing symptoms?:
Provide the actual or approximate date you were most recently on campus:



Additional Information
Is there any other information that you’d like to provide such as the areas or buildings on campus you accessed during the dates indicated above?:

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