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Quarantine Tracking
Quarantine Tracking
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Please complete the following form as part of your quarantine procedure.
Disclaimer: all identifying information entered here is treated as confidential medical records and is only viewed in full by the TWU Public Health Team. Community Life staff will review reports to ensure all resident students required to complete daily quarantine reports do so, but will not access the clinical information enclosed. If you require health care support the Public Health Team may share this information with the Medical team at the Wellness Center but only with your permission. Any reports from the data collected therein will be aggregate data only, for the purposes of tracking workload and disease burden, no names, personal details or medical information will be shared whatsoever.
Quarantine Reason
Quarantine Reason
Travel
I am a suspected or confirmed COVID-19 case
I am a contact of a confirmed COVID-19 case
Is this your first report since arrival?
No
Yes
Arrival Date/Time
(mm/dd/yyyy hh:mm)
Person Category
Person Category
Faculty
Staff
Student
Other
Student Current Residence
Student Current Residence
Non-TWU Resident
TWU Resident
Building
DeVries
Douglas
Fraser Apartments
Fraser Dorms
Jacobson
McMillan
Robson
Skidmore Dorms
Skidmore Suites
Room Number
Have you completed the BCCDC self-assessment today?
No
Yes
Did the app recommend you access medical care?
No
Yes
Details of Medical Recommendation
Best Contact Method
Best Contact Method
Email
Phone
Text
Contact
Questions/Comments
Other Fields
Your name
Your first name
Your last name
Your email address
Verification Code