Self-Reporting Portal (Employees)

Please complete the information below. Once the self-reporting form is received, employees will be contacted by HR with additional instructions, including follow-up about COVID-19 or Monkeypox test result documentation and any other clarifying information.

COVID-19: A determination will be made if an employee can work 100% remotely during isolation. If it is determined you can work from home, no deduction of sick leave will apply. If you are unable to work from home due to incompatible job responsibilities or illness, sick leave will be deducted.

Monkeypox: Employees who test positive will need to isolate for approximately two to four weeks and be cleared by their physician to return to campus. If the roles allow, arrangements to work remotely should be made through HR and the supervisor or utilize sick days until cleared by a physician to return. HR will provide further instructions to employees upon any notification.

Please select one of the following:

COVID-19:

I received a positive test result for COVID-19 (upload results below) I have symptoms and may have COVID-19 but have not been tested or have test results that are pending (suspected case)

You are required to notify your supervisor and any close contacts.
Please submit another self-reporting form once results are received.

Monkeypox:

I received a positive test result for monkeypox (upload results below) I have symptoms of monkeypox but have not been tested or have test results that are pending (suspected case)

Please submit another self-reporting form once results are received.

First Name: Last Name: Title: Phone Number: Email Address: Employee ID Number: Supervisor's Name and Title:

Testing:

Was there a laboratory test for COVID-19 or Monkeypox: (select all that apply) COVID-19 Monkeypox

If there was no test, proceed to the end of the form.

What type of test was conducted?

If an at-home test is used, you must follow up with a medical professional. For additional testing options, refer to Human Resource's intranet page.

What date was the testing conducted?

Test Results:

What clinic, hospital or physician administered your COVID-19 or Monkeypox test? Has medical care been sought?

Information will be used by Prairie State College designated individuals for risk management and to ensure the health and safety of the PSC community. Please ensure you have provided accurate information that can be used to help protect others.

Information will also be used by the Prairie State College COVID-19 Task Force and/or HR to help conduct any case investigation and applicable contact tracing by the local health authority.