UMB asks employees and students whose work brings them 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 UMB 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 report the results of a COVID-19 test.
  • 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 Employee or Student Health for tracking purposes.

If you do develop any of the symptoms below, please do not report to work or school. Instead, please contact your supervisor and the UMB COVID-19 hotline at 800-701-9863. Note: this hotline cannot answer technical questions about the SAFE on Campus process.

If you develop symptoms and you are at work or on campus, 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 UMB'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 Frequently Asked Questions (FAQs) on the SAFE on Campus website: https://www.umaryland.edu/coronavirus/safe-on-campus/

Please complete the survey below.

Thank you!

Loading... Loading...
You have selected an option that triggers this survey to end right now. To save your responses and end the survey, click the button below to do so. If you have selected the wrong option by accident and do not wish to leave the survey, you may click the other button below to continue, which will also remove the value of the option you just selected to allow you to enter it again and continue the survey.
The response has now been removed for the last question for which you selected a value. You may now enter a new response for that question and continue the survey.