H1N1 Self Reporting for Students & Employees This information is confidential and is being used to track the prevelance on our campus. The only exception is for sick students who are remaining on campus who require coordination between Residence Life and Food Services. StudentEmployee Name Address/Residence Hall & Floor Contact Phone Number: SymptomsFever Greater than 101Body AchesChillsFatigueSore ThroatNauseaCongestionVomiting and/or DiarrheaCoughRash HeadacheMildModerateSevere Onset Date HospitalizedYesNo Diagnosed with PneumoniaYesNo Seen by a Health Care ProviderYesNo If you are a student, date/time of departure from campus Submit