COVID-19 Self-Assessment

If you are a vendor or visitor please use the form below. If you are a faculty, staff, or student please click here.

Disclosure Statement for Self-reporting of COVID-19 Symptoms (revised 8/12/2020): As a part of the individual responsibility to help prevent the spread of the COVID-19 virus, individuals are required to conduct a daily check and self-report using an app provided by the University. The data is for the purpose of campus health and safety. Data is stored in a secure manner, and accessible only by staff responsible to review self-assessments and related processes. Positive test results will be shared with GVSU personnel on a need to know basis to facilitate academic support, continuity of operations and contact tracing. Also, the law requires it be shared with the local health department.

Vendor/Visitor Self-Assessment Form

Your Information

Self-Assessment

In the last 48 hours, have you had chills that are new or are getting worse? *
  

Do you have a runny nose, or nasal congestion, that started or has gotten worse in the past 48 hours? *
  

Do you have a severe cough that started or has gotten worse in the last 48 hours? *
  

Do you have nausea or diarrhea that started or has gotten worse in the last 48 hours? *
  

In the last 48 hours have you felt significantly more tired than usual? *
  

Do you have a fever greater than 100F/37.8C? *
  

In the last 48 hours have you had new loss of taste or smell? *
  

Do you have muscle aches that started or has gotten worse in the last 48 hours? *
  

Do you have shortness of breath that started in the last 48 hours? *
  

Do you have a sore throat that started or has gotten worse in the past 48 hours? *
  

Confirmation *

Fields marked with an asterisk (*) are required.


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