COVID-19 Exposure Reporting Form

Students and employees who are experiencing COVID-related symptoms, who believe they have been exposed to COVID-19, or have tested positive must report that information to HR immediately.

You may use this form or call Human Resources at 563-336-3487.

If you have reported an exposure, symptom or positive test result, do not come to campus until cleared by Human Resources.

Requirements for returning to campus after exposure are outlined in the EICC COVID-19 Positive and Presumed Positive Protocols.

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):

Indicated they are experiencing COVID-19 like symptoms

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 EICC’s Equal Employment Opportunity Officer/Equity Coordinator, Eastern Iowa Community College District, 101 West Third Street, Davenport, Iowa 52801, 563-336-5222, or the Director of the Office for Civil Rights U.S. Department of Education, John C. Kluczynski Federal Building, 230 S. Dearborn Street, 37th Floor, Chicago, IL 60604-7204, Telephone: (312) 730-1560 Facsimile: (312) 730- 1576, TDD (800) 877-8339