COVID-19 Self Reporting Form
This reporting form is for individuals affiliated with CTC to notify the College of incidents/persons believed to be affected by the Coronavirus (COVID-19). All reported information is confidential and will be used for statistical data, for the College to take appropriate preventative measures, and to offer available resources. Personal information may be released upon request by public health authorities who may initiate further communication.
Note: Instead of a cell phone, it is suggested you use a device with a larger screen such as an iPad, laptop, or desktop PC when submitting this form.
Please fill out entirely.
Please tell us if you are a...
Campuses you have recently visited (mark all that apply)
Bartow County College and Career Academy
Nature of Report
Confirmed Positive COVID-19 Case
Potential COVID-19 Case
Notification of Self-Quarantine
Notification of Medical Quarantine
Other COVID-19 Concern
Because of the infective nature of the virus, many people may find they've been in contact with someone who has tested positive at home or a different location. Did the exposure or contact occur on any CTC campus or affiliated location?
I'm not sure
Are you planning on travelling internationally?
If you are travelling internationally, please provide the dates of travel and destination.
Please provide any additional comments or information that would be helpful for us to know.
I understand I may be contacted by the Exposure Control Coordinator or by a member of the Chattahoochee Technical College COVID-19 Response Team for clarification of my responses.
Please relay all questions to