Coronavirus (COVID-19) Self-Reporting Form - Nevada State College

Coronavirus (COVID-19) Self-Reporting Form

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Self-Reporting Form

This self-reporting form is to notify the Division of College and Community Engagement at Nevada State College of persons believed to be exposed to the Coronavirus (COVID-19), including yourself. Information reported in this form will be used by a designated NSC administrator to determine appropriate follow-up.

Nevada State College will take every effort to protect personally identifiable information shared in this document and will not disclose your identity or the identity of anyone with a coronavirus diagnosis unless disclosure to safety and first aid personnel is required for emergency treatment or is otherwise required by law. The College may be required to report details, such as temperatures, symptoms, or diagnoses, to public health authorities and other governmental agencies.

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