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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