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COVID-19 Positive or Suspected Case Report


Students who feel they may be ill with or may have been exposed to the Novel Coronavirus Disease 2019 (COVID-19) should consult their primary care physician. Symptoms include: fever or chills, cough, shortness of breath or trouble breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, and diarrhea.

This form is for students at California State University, Long Beach community to report confirmed or suspected cases of COVID-19.

Disclosures to ​those conducting campus exposure investigation about violations of the drug or alcohol policies, or failure to adhere to COVID-related expectations, will not be shared with the Office of Student Conduct and Ethical Development.

You are strongly encouraged to complete this form if any of the following apply to you:

    • You have been diagnosed with COVID-19.
    • You have been referred for testing or told by a health care provider that you have a suspected case of COVID-19.
    • You have come into close contact (closer than 6' for more than 15 minutes) with someone who has a confirmed case of COVID-19.
    • You live with someone who has a confirmed or suspected case of COVID-19.
    • You have been told to self-isolate or self-quarantine by a medical provider or public health authority.
    • You are a faculty or staff member and a student reported to you that they meet any of the criteria above.


Please note:

      The university may be obligated to notify the City of Long Beach Health Department of any positive cases of COVID-19 which it is aware.


Upon receipt of this form, University staff will follow up with the individual referred in order to check in with them, gather additional information to assist with initial exposure investigation, assess their needs, and communicate appropriate return to school/work protocols.

For more information on CSULB's response to COVID-19, please visit our website.

Reporter Information

 
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Student or Employee Information

Please fill out as much information as you can about the student this report concerns.

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Questions

Has this individual had or reported a positive COVID-19 test?(Required)
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If the individual has not yet been tested, are they planning to be?(Required)
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Is this individual currently experiencing COVID-19 symptoms? (e.g., fever or chills, cough, shortness of breath or trouble breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, and diarrhea.)(Required)
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Has the individual been on campus within 48 hours of the onset of symptoms OR within 48 hours of their positive COVID test?(Required)
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Do you live in University Housing?(Required)
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It is your responsibility to coordinate with faculty regarding absences, coursework, and assignments.(Required)
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Supporting Documentation

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