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Medical/COVID-19 Referral Report


Anyone with a confirmed case of infectious illness, such as COVID-19, monkeypox, flu, or strep throat, should report their illness through the Medical/COVID Referral Reporting Form. You may also report concerns on behalf of another individual. You do not need to report exposure to an individual with an infectious illness unless you have developed symptoms, in which case you need to isolate and seek a medical provider for evaluation. 


If there is an IMMINENT THREAT to anyone's safety or if there is an EMERGENCY IN PROGRESS, please DO NOT FILE A REPORT until after having first called Public Safety at 313-993-1234 (or ext. 1234 from a campus landline).

Please contact the Dean of Students Office if the imminent concern involves a student at 313-993-1028 or the Office of Human Resources if the concern involves an employee at 313-993-1036. The Dean of Students Office and Human Resources will review and process reports during business hours only. 

 

Your information (reporter)

Please complete this form as comprehensively as you can, including all information that is known to you. While anonymous reports are accepted, you are STRONGLY encouraged to provide your name and contact information to allow us to address the concerning behavior most effectively. 

 
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Please indicate the role of the community member you are concerned for:

Involved Parties (concern involving)

Involved party 1

Witnessed Concerns and/or Observed Behavior

Please select the following indicators that have been observed or reported. Please provide additional details of the incident or concern in the narrative box below.

I am concerned about a:(Required)
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The Medical/COVID-19 concern consists of: (Please check all that apply):(Required)
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ASSISTANCE AND NEXT STEPS: Following your submission of this report, you will receive a reply confirmation. The email will contain resources on illness, isolation, and testing. Please check any applicable information below:
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Supporting Documentation - Optional

Photos, video, email, screen shots, and other supporting documents MAY BE attached below. 1GB maximum total size. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

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