School of Nursing: COVID-19 Exposure and Question Form

School of Nursing: COVID-19 Exposure and Question Form

To help guide you in taking care of yourself and reduce the communication burden on any individual who experiences a COVID exposure situation, we are implementing a resource for the School of Nursing Community: COVID Coaches. Coaches are seasoned faculty prepared to provide the most accurate information that people in the nursing community need regarding COVID-19.

COVID Coaches will help you identify and understand COVID-19 guidelines from Texas A&M University regarding questions you have about what to do in case of exposure and/or symptoms of COVID-19. The Texas A&M University guidelines are the primary source of university guidance. Even though you are completing this inquiry form, if you have an exposure or symptoms, you are required to read the guidelines from Texas A&M and complete the required COVID-19 Report Form.

For students: The COVID Coach will help you determine accurate information regarding class and clinical timelines related to COVID-19 exposure, positive tests, or symptoms. Coaches will also inform your course faculty of absence dates saving you those emails. Your focus is to take care of yourself.

Please use this form to provide the basic information the COVID Coach needs to advise you properly.

Refer to Texas A&M Student Rule 7 and the University’s Covid-19 guidance to ensure you are following the most up-to-date guidance. It is important to pay particular attention to section 7.1.1 related to deadlines to notify faculty of absences. Additionally, it is critical to understand that this information may be shared with appropriate University personnel to confirm student attendance, absences, and consistent application of your requests for absences.

The Texas A&M University COVID-19 Guidelines and reporting form are available at covid.tamu.edu.

Please affirm: *

Please affirm: I am a person who received a positive test result for COVID-19. I am a person who has been exposed to a person who tested positive for COVID-19 and am unwilling/unable to wear a mask.
Please affirm: *

Please affirm: I am reporting my own confirmed COVID-19 illness.
If I use this documentation to secure an excused absence in a class session but attend, in-person, other class sessions in the same timeframe covered by this excuse, this excuse may be invalidated and/or I may face allegations of academic misconduct for fabrication *

If I use this documentation to secure an excused absence in a class session but attend, in-person, other class sessions in the same timeframe covered by this excuse, this excuse may be invalidated and/or I may face allegations of academic misconduct for fabrication I understand that Texas A&M University may monitor this documentation and share it with appropriate personnel.
First Name *
Last Name *
UIN *
Maximum of 9 characters allowed. Currently Entered: 0 characters.
TAMU email address *

Please only list your TAMU email address.
Phone Phone * - ### - ### ####
Texas A&M University School of Nursing cannot require you to disclose your vaccination status. Answering the following questions is completely voluntarily. In order to accurately answer your questions and provide guidance, your voluntary response will guide the decision making and recommendations of COVID Coaches.
COVID-19 Vaccination Status *

COVID-19 Vaccination Status Fully vaccinated Partially vaccinated Unvaccinated Undisclosed (If this option is selected, the COVID Coaches will provide COVID recommendations as if you are not fully vaccinated.)
Is there any additional information you would like to share with the COVID Coaches? This will help the COVID Coaches advise you (circumstances of exposure, individual health risks, questions you have, etc.)
Campus/location *

Campus/location Bryan-College Station Round Rock Lufkin McAllen
What is your role in the School of Nursing community? *

What is your role in the School of Nursing community? Pre-licensure BSN student RN to BSN student MSN-Nursing Education student MSN-Family Nurse Practitioner student MSN-Forensic Nursing student Faculty Staff
Please share your cohort.
(For example: Traditional BSN, Fall 2022. If you are faculty or staff, please mark N/A.) *
I need advice about: *

I need advice about: Close contact community exposure Clinical exposure COVID testing Illness (signs/symptoms) I do not need advice.
The CDC defines a close contact as being within 6 feet for a cumulative total of 15 minutes or more over a 24-hour period regardless of wearing a face covering with someone who has or is suspected to have COVID-19, or someone in your household who has been diagnosed with or received a positive test result for COVID-19.
Please include details specific to your situation and/or question(s). *
Exposure date Exposure date * / MM / DD YYYY
Does the person you had contact with have COVID-19 symptoms? *

Does the person you had contact with have COVID-19 symptoms? Yes No Unknown
Did the person you had contact with test positive for SARS-CoV-2 coronavirus (within 48 hours of close contact)? *

Did the person you had contact with test positive for SARS-CoV-2 coronavirus (within 48 hours of close contact)? Yes No Unknown
Did you have close contact? *

Did you have close contact? Total of 15 minutes or more, over a 24 hour period, within 6 feet Sharing a bathroom and/or kitchen Other Other
Although responding to the following questions is not required by the School of Nursing, your voluntary responses will guide the decision making and recommendations of COVID Coaches.
Have you been tested? *
Date of test (if you have not been tested please mark as 01/01/2001) Date of test (if you have not been tested please mark as 01/01/2001) * / MM / DD YYYY

If you have not been tested, please mark as 01/01/2001.
Test result *
Type of test *
Are you having any symptoms? *
If so, what symptoms are you experiencing? (If you are not experiencing symptoms, please list none. *

If you are not experiencing symptoms, please mark as none.
When did your symptoms begin? (If you are not experiencing symptoms, please mark 01/01/2001. When did your symptoms begin? (If you are not experiencing symptoms, please mark 01/01/2001. * / MM / DD YYYY

If you are not experiencing symptoms, please mark as 01/01/2001.
Undergraduate students, please select the courses in which you are currently enrolled: *

Undergraduate students, please select the courses in which you are currently enrolled: N/A 305 306 307 312 315 316 320 323 411 412 413 420 421 424 430 434
Please list the first and last names of your faculty. (If you are faculty & staff, please list N/A. *
RN-BSN students, please select the courses in which you are currently enrolled: *

RN-BSN students, please select the courses in which you are currently enrolled: N/A 460 461 462 463 464 465 466 467 468
MSN-Nursing Education students, please select the courses in which you are currently enrolled: *

MSN-Nursing Education students, please select the courses in which you are currently enrolled: N/A 617 618 630 631 632 633 634 638 651 652 653 654 656
MSN-Family Nurse Practitioner students, please select the courses in which you are currently enrolled: *

MSN-Family Nurse Practitioner students, please select the courses in which you are currently enrolled: N/A 617 618 620 621 622 623 624 625 651 652 653 654 656
MSN-Forensic nursing students, please select the courses in which you are currently enrolled: *

MSN-Forensic nursing students, please select the courses in which you are currently enrolled: N/A 617 618 601 602 603 604 638 651 652 653 654 656
Please provide any details or additional information you think would be helpful to know.
The information provided in this report will be protected and kept private to the fullest extent possible.

"An Aggie does not lie, cheat or steal, or tolerate those who do."

On my honor as an Aggie, I have accurately and honestly completed this self-reporting COVID-19 form and have not altered or misrepresented any of its contents.

Type your full name below to acknowledge. *