Student COVID-19 Reporting

Student Form for COVID-19

You can use this form to notify the college if you test positive for COVID-19. Students are encouraged, but not required, to complete this form. Your report will help us keep track of exposures and may reduce the risk of further spreading.

If you have a positive test result for COVID-19, please upload a copy of your test result through the PyraMED Health Portal: Log in to deanza.studenthealthportal.com and click the "Upload" tab.

First Name*

Last Name*

Date of test*

Was the test PCR (administered by a health care professional, for which you had to wait a period of time for the results) or antigen (a home test or one performed by a health care professional, for which you received immediate results)

PCR

Antigen

Both

Date symptoms began, if any *

Signs and symptoms*

Please list any on-campus classes you are currently taking and the instructors' names for those classes

Course ID (for example "EWRT 2")

Instructor

Added Courses

No courses have been added yet.

Date of Your Last Visit to Campus*

Please list all of the building and rooms you visited on that date:

Building

Room

Added Locations

No locations have been added yet.

With whom have you been in close contact from your class(es) since the onset of symptoms or receiving the positive test result? (Close contact is defined as someone with whom you were within six feet of for at least 15 minutes beginning two days before you had symptoms or tested positive.)

First Name

Last Name

Close Contact with:

No one has been added yet.

You must log in with your CWID and MyPortal password to continue.

CWID*

MyPortal Password*