Introduction and Instructions
Please answer the questions below to the best of your ability. If you do not know the answer or if it does not apply, leave the answer blank, or enter N/A as needed; please do not guess.
Faculty and staff submitting a report on behalf of a student can email their report to firstname.lastname@example.org.
CCC may follow-up with anyone who completes this form for additional information. If needed, the Incident Management Team will coordinate the appropriate cleaning and disinfecting of any affected spaces on campus and address any other concerns that may arise.
When possible, all personal information will be kept confidential. Any notifications made will not include personal identifying information.
Coconino Community College is dedicated to the health and safety of all people. Therefore, the college will fully cooperate with the Coconino County Department of Health and Human Services (CCDHHS) with aiding in tracing all known avenues of COVID-19 infections among staff, faculty, and students. Furthermore, CCC will be supplying CCDHHS staff, through its encrypted web-based reporting portal, personal identification information that is exempted, during the pandemic, from the Health Insurance Portability and Accountability Act (HIPAA) and the Family Educational Rights and Privacy Act (FERPA). This exempted information, in the context of the pandemic, includes: first and last name, address, date of birth, gender, phone number, date of illness onset, date last present in the facility, date of positive COVID-19 test, symptoms if reported, class schedule, and a list of people who were in close contact.