COVID Reporting Form

If you test for COVID-19 and receive a positive result, or if you are named a contact of a positive case by a health official, please complete the entire form below.

Please review the following information prior to completing the form:

Employee positive test result forms are sent to the Human Resources Office and the Director of Health & Safety only. Employees who test positive for COVID-19 will be contacted by the Human Resources Office in regards to work from home and return to work plans.
Student positive test result forms are sent to the Director of Student Health Services, Executive Director of Housing & Student Life, Registrar, and Interim Vice President of Student Affairs and Enrollment Management. Students who have tested positive must remain off campus until they are cleared by Student Health Services to return to campus. Residential students are expected to travel home until they are cleared to return to campus.

Information on all positive test cases may be shared, in a limited manner to preserve the privacy of the individual, with members of President’s Cabinet and the COVID Task Force.

All guidelines and decisions regarding COVID-19 are based on guidance from the CDC, state and federal government with the primary goal to keep our campus community safe. WLU appreciates your adherence to those guidelines. If you have questions, please email covid19@westliberty.edu.

If you have any problem seeing the form below, please try to access through Google Chrome or Microsoft Edge. If you continue to have difficulty, email residencelife@westliberty.edu for assistance (students and employees) since this office created the form. Thank you.

Name*
First Middle Last
Preferred Name (if applicable)
WLU ID Number (including @ symbol and all digits*
Are you a student or employee?*
WLU Email Address*

WLU will communicate information to you through this email address.
Cell Phone Number*
Reason For Reporting Status*
If you are a student who has tested positive at an off campus location, please remember to upload a copy of your positive test result with name and date visible to your student health portal.
Who was the positive COVID patient that you were named a contact of by a health official?*
First and Last Name, and indicate if they are a student or employee of WLU
Are you up to date on your COVID vaccines?*
- No
- Yes
Up to date means your original series was complete in the last 5 months, or you have received a booster since the original series.
Date of Positive COVID-19 Test or Contact with Positive Patient*
MM slash DD slash YYYY
Where did you have your COVID test?
Students: Please be sure to upload a picture of your COVID test results to your student health portal. Make sure the result includes name, date of birth, and date of the test.
As a positive case, have you experienced or are you currently experiencing symptoms?
What date did your symptoms begin?
MM slash DD slash YYYY
Please select any symptoms you are or have experienced.
- Body Aches
- Congestion
- Cough
- Fever
- Sore Throat
- I have not experienced any symptoms
Residence Hall/Off Campus Information*
On Campus Residents Only: Room, Apartment, or House Number
Athletics Participation*
Please list any locations you have visited on campus within the past 72 hours:*
Specify building and room numbers, include your residence hall if you have been in that facility during the last 72 hours.

*PLEASE NOTE: Protocol is subject to change

Sources:

RESIDENCE LIFE

Residence Hall Pictures

RESOURCES

CONTACT