Chattahoochee Technical College
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.

YOUR INFORMATION


Please fill out entirely.
  1. First Name:

  2. Last Name:

  3. Email Address:

  4. Phone Number:

  5. Please tell us if you are a...

  6. Campuses you have recently visited (mark all that apply)












  7. Nature of Report







  8. 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?

  9. Are you planning on travelling internationally?



  10. If you are travelling internationally, please provide the dates of travel and destination.



  11. Please provide any additional comments or information that would be helpful for us to know.




Please press Submit ONLY once.