COVID-19 - Employee and Student Voluntary Disclosure

The university is asking faculty, staff and students to utilize this form to voluntarily disclose whether they are in self-quarantine for any of the reasons listed below.

The information will be kept confidential in accordance with HIPAA and FERPA, and will be used to assist HR in tracking employees’ use of sick leave, to help Student Development understand the impact of students on campus, and to aid the Milwaukee Health Department in their contact investigations when new coronavirus cases are identified. For employees, voluntary disclosure will have no implications for one’s job status.

 

I am in self-quarantine because (check one):
I am:
Have you been on campus in the last 14 days?