First Name:
Last Name:
SWOCC ID Number:
Email Address:
Date of Birth:
Phone Number:
Date of Exposure, if known:
Please list your association with SWOCC:
If other, please specify:
Have you received a COVID-19 Vaccination?
What is the status of your COVID-19 Vaccine?
Have you received a booster vaccine?
Wear a tight fitting mask for the next 10 days. If possible, get tested 5 days after your exposure. If you experience any COVID-19 symptoms, do not come to campus and get tested.