MNTC Exposure Report
Complete this form if:
In the last 10 days you have tested positive for COVID-19
In the last 10 days, you were exposed to or cared for someone diagnosed with COVID-19.
I am a/an MNTC:
What site is your primary place of work or study?
Franklin Road Campus - A or B Area (e.g., Near Admin / Assessment / Student Services)
Franklin Road Campus - C or D Area (e.g., Near Welding/Cosmetology)
Franklin Road Campus - Technical Trades Building (i.e., HVAC or Electric)
Franklin Road Campus - Carpentry Building
Franklin Road Campus - Bus Barn
Franklin Road Campus - BIT Building (e.g., Near Graphic Design or Networking)
Franklin Road Campus - Health Building (i.e. Any health program)
Franklin Road Campus - HIRE Building
South Penn Campus - Conferencing Side
South Penn Campus - Educational Side
South Penn Campus - North Building (Formerly BDC)
Which situation are you reporting?
In the last 10 days I have tested positive for COVID-19
In the last 10 days, I was exposed to or cared for someone diagnosed with COVID-19 and I am not fully vaccinated and/or I have not recovered from COVID-19 within the last 90 days.
I have traveled by commercial transit in the last 5 days. (airplane, boat, commercial bus, etc.)
Give us a description of travel:
Give description of social setting"
When did you test positive for Covid-19?
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Date of Exposure
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Where did the exposure take place?
Has the person to whom you were exposed tested positive for COVID-19?
Result of test
Have you been on MNTC's campus any time in the last 10 days?
Please provide any additional information that might help us respond to this situation.
I certify to the best of my knowledge; the information provided in this form is accurate.
Yes, the information is accurate.
Should be Empty: