Notification form Corona

First name

Last name

Student ID

Campus

Mobile

E-mail

Are you quarantined or isolated? Yes, in quarantine Yes, in isolation No

When did you get symptoms?

Have you been tested? Yes, I've tested positive Yes, I've tested negative Yes, waiting for results No

If yes, when did you get a positive test?

When was the last time you were at campus? (describe where and when, in contact with employees?)

Have you attended any lectures? If yes, please specify course, date and time.

Are you a student assistant at BI? Yes No

Are close contacts notified by the local health authorities? Yes No