COVID-19 Self-Reporting Form
WHO SHOULD COMPLETE THIS FORM?
To ensure that Northern Oklahoma College can provide support and resources to students and employees, the College is requesting that the COVID-19 Self-Reporting Form be submitted by an individual when:
- You have received a positive COVID-19 test result
- You have been exposed to COVID-19 (direct contact within six feet of an infected person for a cumulative total of 15 minutes or more over a 24-hour period)
- You have symptoms of COVID-19 but have not been tested or have test results that are pending (A comprehensive list of COVID-19 symptoms can be found on CDC website)
- You have an update to provide to any of the above
Students are required to immediately self-report to the appropriate campus administrator a positive COVID-19 test or a primary exposure contact with an individual who has tested positive.
Employees are required to immediately self-report to the appropriate campus administrator for contact tracing, as well as notifying their immediate supervisor and the HR Director if they have had a positive COVID-19 test or primary exposure contact with an individual who has tested positive.
- Enid Campus: Jeremy Hise, Vice President for NOC Enid, 580.548.2393
- Stillwater Campus: Jason Johnson, Vice President for Student Affairs, 580.628.6272
- Tonkawa Campus: Jason Johnson, Vice President for Student Affairs, 580.628.6272
- Human Resources: Shannon Cranford, Director of HR, 580.628.6229
WHAT DOES THIS FORM DO?
This form is how you will notify appropriate campus administrators on the emergency response team and Human Resources about your condition. It will create an email confirmation of the report for illness/exposure/monitoring, help reduce potential exposure to the campus community, and allow the College to assist the ill students, employees, and guests connecting them with needed services. This form does not take the place of the daily self-screening.
WHAT HAPPENS NEXT?
Individuals completing this self-reporting form will be contacted by a campus administrator (see campus contacts). If you are experiencing symptoms of COVID-19, or a campus administrator deems it necessary in consultation with the health department, you will then be directed to a health agency for further evaluation and testing. Please Note: The College is committed to ensuring that your submission remains private and only will be utilized as a means to provide support and resources.
For a full list of county drive-through testing in Oklahoma, go to https://coronavirus.health.ok.gov/testing-sites. Some health departments also advise the public to check their Facebook pages for more information regarding testing.
State Department of Health Coronavirus Hotline – 1.877.215.8336
If you have any questions about self-reporting or concerns or do not have access to a computer to complete the self-reporting form electronically, please contact Jason Johnson, Vice President for Student Affairs, at 580.628.6272 or firstname.lastname@example.org.
Please complete this electronic form and submit. Your honest and accurate response will help contract tracers with the investigation.