COVID-19 Positive Test Result

COVID-19 Positive Test Result

Please fill out this form to self-report a positive COVID-19 test.

Self-reporting this information helps protect the ORU community.

Your privacy is of utmost importance to us. Faculty/Staff information will be routed directly to Human Resources and student information will be routed directly to Student Life, who will initiate necessary protocols for cleaning affected areas, implementing quarantine if applicable, etc.
Upon receipt, an ORU Case Manager will contact you with further instructions.

Your Name Your Name First Last
Z Number, if known
Your Cell Phone Your Cell Phone - ### - ### ####
ORU Email
This form is submitted on behalf of

This form is submitted on behalf of Myself Someone Else
Name of Contact you are submitting this form on behalf of Name of Contact you are submitting this form on behalf of First Last
Contact's ORU Classification

Contact's ORU Classification Residential Student Commuter Student Faculty Member Staff Member
What is your relation to the contact?

I am his/her:

What is your relation to the contact?

I am his/her: Supervisor Co-worker Faculty Member Student Leader Other
Relation to contact - Other:
I am a: (select all that apply)

I am a: (select all that apply) Residential Student Commuter Student Student Worker Faculty Member Staff Member
Student Worker in: (location/department)