COVID-19 Self-Reporting Form for Faculty & Staff

To ensure that Ashland University can provide support and resources to faculty and staff who have been exposed to or tested positive for COVID-19, the University is requesting that individuals (or a designee) complete the form below. This information will also assist Ashland University and public health officials with monitoring the incidence of cases occurring in our community.

Please Note: Ashland University is committed to ensuring that your submission remains private and only will be utilized as a means to provide support and resources. Your submission is not a substitute for medical advice. If you are in medical distress, please call 911. If someone is diagnosed with a confirmed case, the Ashland County Health Department (or if a remote employee, the local health department) works to make sure those who have been exposed are contacted. The employee may choose to self-disclose medical information to anyone of their choosing, but that still does not allow supervisors/managers, HR, university leadership, or colleagues to re-release or discuss that information to or with that employee’s colleagues.

If you would prefer to print a paper form and fax it, you may download the self-reporting form and fax it to Michelle Neville at 419.289.5993.