COVID-19 Reporting Form

Please use this form to submit/self-submit a report of COVID-19 symptoms, exposure or positive results.

Asterisk (*) indicates a response is required.

Please make sure after clicking the submit button that you receive a confirmation message on the screen and copy of your submission at the email address you provided. If you do not receive a confirmation message and email, your submission was not completed and has not been sent.

For the person making the report:

If reporting about a student:

*This person has (check all that apply):

Been referred to the HealthCheck360 Medical Hotline at 1-855-716-2588 for assessment due to risk factors (symptoms, possible exposure)

Indicated they are scheduled for COVID-19 testing

Indicated they are awaiting results of a COVID-19 test

Indicated they tested positive for COVID-19

It is the policy of Eastern Iowa Community College District not to discriminate in its programs, activities, or employment on the basis of race, color, national origin, sex, disability, age, sexual orientation, gender identity, creed, religion, and actual or potential family, parental or marital status, as required by the Iowa Code §§216.6 and 216.9, Titles VI and VII of the Civil Rights Act of 1964 (42 U.S.C. §§ 2000d and 2000e), the Equal Pay Act of 1973 (29 U.S.C. § 206, et seq.), Title IX (Educational Amendments, 20 U.S.C. §§ 1681-1688), Section 504 (Rehabilitation Act of 1973, 29 U.S.C. § 794), and Title II of the Americans with Disabilities Act (42 U.S.C. § 12101, et seq.).

If you have questions or complaints related to compliance with this policy, please contact Debora J. Sullivan, Equal Employment Opportunity Officer/Equity Coordinator, Eastern Iowa Community College District, 101 West Third Street, Davenport, Iowa 52801, 563-336-3487, djsullivan@eicc.edu or the Director of the Office for Civil Rights, U.S. Department of Education, Citigroup Center, 500 West Madison Street, Suite 1475, Chicago, Illinois 60661-7204, phone number 312-730-1560, fax 312-730-1576, OCR.Chicago@ed.gov.