UB asks employees or students who will be coming to campus or otherwise working together to monitor themselves daily for symptoms that may be related to COVID-19.

This Episodic Symptom Monitoring Report Form can be used for several different purposes:

  • If you are already on a pause from daily symptom monitoring, but need to come into work or to attend school activities on a one-time or infrequent basis during a longer period of remote working or learning.
  • If you have already responded to your daily survey that you are not planning to be on campus, and your plans later change.
  • If you are a visitor or other person not registered in the UB daily monitoring program, who has been asked to report your symptoms before coming to campus for business.
  • If you are on a pause from daily monitoring, but would like to make a change in your status, such as change the restart date for reminders, or change your supervisor.

Please complete this form before coming to work or school activities

This form will be submitted to Human Resources or Student Support for tracking purposes.

If you do develop any of the symptoms below, please do not report to work. Please contact your supervisor.

If you develop symptoms and you are at work, then please put on a surgical mask or cloth face covering, contact your supervisor and make plans to leave immediately.

Note that you should be wearing a face covering in accordance with UB's face covering policy. This policy requires wearing a face covering while on campus with very limited exceptions.

If you have any questions or concerns, please check the Fall 2020 Pandemic Planning Page: http://www.ubalt.edu/about-ub/fall-2020-pandemic-planning/index.cfm

Please complete the survey below.

Thank you!

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