SRJC COVID-19 Positive Exposure Incident Report

I. Employees

The SRJC COVID-19 Positive Exposure Incident Report was created to report a suspected or confirmed case of COVID-19 at SRJC. The link is provided in place of the retired PDF version in order to facilitate case tracking and contact tracing.

  • The online form is automatically sent to the COVID Response Team upon submission.
  • District Employees will fill out this form on the behalf of:
    •  Any employee, student, or visitor who informs them of a confirmed or suspected case of COVID-19.
  • District Employees must notify their Supervising Administrator as soon as possible.
    • No later than eight hours after learning of the reported COVID-19 exposure.

II. Students

Direct students, if they have been exposed to a COVID-19 positive individual or have tested positive for COVID-19, to please contact SRJC Student Health Services (SHS) immediately for their assistance in completing this Incident Report.

III. Filling Out the Form

Please respond to all questions to the best of your ability. To complete this form, be prepared with the following information:

  • Name and contact information
  • Student/employee ID number
  • Role of Affected Individual (student/employee/volunteer/other)
  • Building and specific locations accessed
  • Classes attended while infectious
  • COVID testing information and general health status

SRJC COVID Positive Exposure Incident Report