Self-Reporting Illness Form

If you do have flu symptoms, please report the illness to Student Health Services via the phone (961-1604) or this form. Students should report by phone to their CA or to the Res Life Duty phone if illness occurs after SHS office hours or the weekend.

Name:
Simpson Email Address:
Residence Hall Name/Room Number:
Cell Phone Number:
Room Phone Number:
Indicate the date on which you developed flu-like symptoms:
Please provide any relevant details concerning your absence and/or how you are feeling:
Are you going to go home for the recovery process or self-isolate?	Go home for the recovery process Self-Isolate
Additional information regarding your immediate plans:

Simpson College

Self-Reporting Illness Form