COVID-19 Self-Reporting Portal (Employees)
Step 1 of 2: Submit
Please complete the information below. Once the self-reporting form is received, employees will be contacted by HR for additional instructions, including follow-up about COVID-19 test result documentation, and any other clarifying information.
A determination will be made if an employee can work 100% remotely during self-quarantine. If it is determined you can work from home, you will receive full-pay. If you cannot work from home, your supervisor and payroll are informed that emergency sick pay under FFCRA will apply.
Please select one of the following:
I received a positive test result for COVID-19 (a laboratory confirmed case).
I have been tested for COVID-19, and results are pending (suspected case).
I have been in close contact* with someone who received a positive test result for COVID-19.
For COVID-19, a close contact is defined as individual exposures added together over a 24-hour period (e.g., three 5 minute exposures for a total of 15 minutes), and includes 15 cumulative minutes of exposure at a distance of six (6) feet or less of an infected person starting from two (2) days before illness onset (or, for asymptomatic patients, two (2) days prior to positive specimen collection) until the time the patient is isolated.
Employee ID Number:
Supervisor's Name and Title:
Date last on campus:
What areas of campus did you visit while on campus on the last day you visited and at least 48 hours before symptoms started?
If known, please list all individuals in possible close contact starting from 48 hours before symptoms started?
Laboratory Testing for COVID-19
Has medical care been sought?
Select an option:
Was there a laboratory test for COVID-19?
Select an option:
If there was no test, proceed to the end of the form.
What type of test was conducted?
Unsure / Unknown
What clinic, hospital or physician administered your COVID-19 test?
What date was the testing conducted?
The information provided in this report will be protected and kept private to the fullest extent possible.
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 to help conduct the case investigation and contact tracing by the local health authority.
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