COVID-19 Report Form

The college expects that students and employees report positive cases or possible exposure to COVID-19 use the COVID Report form or one of the following methods:

Students: Contact Sabrina Terry, Dean of Student Services, at terrysj@surry.edu or 336.386.3530

Employees: Contact Melonie Weathers, Director of Human Resources, at weathersm@surry.edu or 336.386.3207

When a positive case is identified on campus, the Dean of Student Services and Director of Human Resources conduct contact tracing and notify all impacted parties. The affected classroom or building space is closed until the area is deep cleaned and fully sanitized.

Question Title

* 1. Name

Question Title

* 2. Affiliation to the College

Employee

Student

Visitor

Question Title

* 3. Phone Number

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* 4. Email

Question Title

* 5. Nature of Report (Check all that apply)

Awaiting COVID-19 Test Results for Self

Awaiting COVID-19 Test Results for Household Member

Confirmed COVID-19 Case

Exhibiting COVID-19 Symptoms

Potential COVID-19 Exposure

Question Title

* 6. College/Site Affiliation- (Check all that apply)

Main Campus - Dobson

Center for Public Safety - Mount Airy

Elkin Center - Elkin

Pilot Center - Pilot Mountain

Yadkin Center - Yadkinville

Other (please specify)

Question Title

* 7. Last Date You Visited College/Site Affiliation

Date / Time

Date