Notification of COVID-19 related symptoms for Contractors – Human Resources

We ask that direct contractees notify the College and of their COVID-19 related symptoms or need to isolate/quarantine due to COVID-19.

Please complete this form if any of the scenarios below apply to you:

you have been or are scheduled to be tested for COVID-19 due to symptoms or exposure
you have unexplained symptoms like a fever, cough, difficulty breathing, sore throat, muscle aches, or sense of taste or smell.
you were notified by a local or state department of health of a known or potential exposure to COVID-19
you have had contact with someone who has tested positive for COVID-19

Notification of COVID-19 Symptoms for Contractors

This form can be used for contractors to inform Carleton Human Resources of any COVID-19 like Symptoms. THIS FORM SHOULD NOT BE USED BY EMPLOYEES WITH A CARLETON EMAIL ADDRESS

Your Full Name * Required
Your Department * Required
Your Email * Required
Your Title * Required
Do any of the scenarios described above apply to you? * Required
- Yes
- No
Please provide the date your symptoms or quarantine started - must be mm/dd/yyyy format * Required
Date Format: MM slash DD slash YYYY
Human Resources will maintain all information about illnesses as a confidential medical record in compliance with the ADA.
Name
This field is for validation purposes and should be left unchanged.

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