COVID-19 Visitor Symptom Tracking Form

Welcome to Michigan Tech's Visitor Symptom Tracking Form. Prior to visiting campus you should fill out this form with your contact information and current symptoms. If your symptoms do not meet CDC guidance for warning signs of COVID-19, you will be provided with a confirmation code that you will be asked for when you visit campus.

If you have a question regarding the symptom monitoring portal or a COVID-19 related questions, please contact MTUFlex@mtu.edu or call Heidi Reid at 487-2229.

First Name *

Last Name *

Phone Number *

Email Address *

Reason for visiting campus *

Department you are visiting (required if reason for visit is Other)

Contact for the department you are visiting (required if reason for visit is Other)

Name of Student (required if reason for visit is Moving in a Student or Housing)

In the last 14 days, have you been in close contact (closer than 6 feet for 15 or more cumulative minutes within a 24 hour period) with someone you know or suspect to be infected with COVID-19?*

Yes

Did this person test positive for COVID-19?*

Yes

I don't know

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