The SRJC COVID-19 Positive Exposure Incident Report was created for individuals accessing district worksites to report a suspected or confirmed case of COVID-19 at SRJC. Please complete the form if you access district worksites and have a suspected or confirmed case of COVID-19. Completing the form helps to facilitate case tracking and contact tracing, and assists the district's COVID Response Team with determining your work status.
- The online form is automatically sent to the COVID Response Team upon submission.
- District Employees will fill out this form on the behalf of:
- Any employee, volunteer, student, or visitor who informs them of a confirmed or suspected case of COVID-19.
- District Employees must notify their Supervising Administrator as soon as possible.
- No later than eight hours after learning of the reported COVID-19 exposure.
Direct students, if they have been exposed to a COVID-19 positive individual or have tested positive for COVID-19, to please contact SRJC Student Health Services (SHS) immediately for their assistance in completing this Incident Report.
- Students should contact SHS by calling (707) 527-4445, or send an email to firstname.lastname@example.org.
- An SRJC Employee, such as an instructor or department dean, may offer support.
- Visit the SRJC SHS website for additional information and resources available to students related to COVID-19 prevention, including current information on the availability of COVID testing within Sonoma County. SHS can also schedule free COVID Vaccination appointments at SRJC.
III. Filling Out the Form
Please respond to all questions to the best of your ability. To complete this form, be prepared with the following information:
- Name and contact information
- Student/employee ID number
- Role of Affected Individual (student/employee/volunteer/other)
- Building and specific locations accessed
- Classes attended while infectious
- COVID testing information and general health status
SRJC COVID Positive Exposure Incident Report
- Please contact SHS by calling (707) 527-4445, or send an email to email@example.com if you are reporting a suspected or confirmed case of COVID-19 at SRJC, or need information regarding district quarantine or isolation requirements.
- Contact Linda Jay at firstname.lastname@example.org if you have questions regarding COVID sick leave.
- For additional assistance or questions, please contact the Human Resources Employee Health and Safety staff at email@example.com or call (707) 527-4803.