University Health Services

COVID-19 Forms

• COVID-19 Screening Form: To be completed when an employee or student needs to report a positive COVID-19 result. This form should be completed by the affected employee or student. 
• Requesting a clearance to return to campus after testing positive for COVID-19: To be completed when an employee or student needs clearance to return to the UTHSC campus after testing positive for COVID-19 and to request for an ID badge reactivation. A clearance is provided when this form is signed by a University Health Services provider. Email this form to University Health Services at eohs@uthsc.edu.