COVID-19 Signs and Symptoms

Use this form to report if you are experiencing signs and symptoms of COVID-19.

Please stay home, isolate, and get tested within 24 hours of signs and symptoms.

Name Name First Last
Date of Birth Date of Birth / MM / DD YYYY
Medaille ID Number
Must be 8 digits. Currently Entered: 0 digits.
College Email
Phone Phone - ### - ### ####
College Affiliation

College Affiliation Student Faculty/Staff
Campus Affiliation

Campus Affiliation Buffalo Rochester N/A (Online)
Do you live in the residence halls?

Do you live in the residence halls? Yes No
Are you affiliated with Medaille College Athletics?

Are you affiliated with Medaille College Athletics? Yes No
Are you a member of club hockey or club cheerleading?

Are you a member of club hockey or club cheerleading? Yes No
Are you fully vaccinated against COVID-19 (meaning you also have received a booster if eligible)?

Are you fully vaccinated against COVID-19 (meaning you also have received a booster if eligible)? Yes No
If you have not already provided a copy of your COVID-19 vaccine card, please do so here.

Attach Files
Please select the first day you began to notice signs/symptoms of COVID-19 Please select the first day you began to notice signs/symptoms of COVID-19 / MM / DD YYYY
Are you experiencing any of the following (please select all that apply):

Are you experiencing any of the following (please select all that apply): Fever Chills Cough Shortness of breath/Difficulty breathing Unusual fatigue Unexplained muscle or body aches Unexplained headache New loss of taste or smell Sore throat Congestion or runny nose not caused by seasonal allergies Nausea or vomiting Diarrhea
Disclaimer:
This list does not include all the possible symptoms of COVID-19. The CDC will update the list of symptoms as we learn more about COVID-19 variants.