Mount St. Joseph University

If you are a Mount employee or student, please access your version of the questionnaire by clicking or selecting this link. You will need to login to myMount to continue on to the form after selecting the link.

All visitors must complete this questionnaire before going to any location on campus. Questionnaires are stored securely and treated confidentially in accordance with all applicable laws. Failure to complete the questionnaire may result in the denial of access to campus. Questions may be directed to University's Director of the Office of Human Resources, Lisa Kobman, at 513-244-4979 or lisa.kobman@msj.edu.

COMPLETE THE FOLLOWING INFORMATION ABOUT YOUR VISIT TO CAMPUS TODAY. ALL QUESTIONS ARE REQUIRED.

Name

Purpose for today’s campus visit

On campus destination

Name of person(s) you are seeing (enter N/A if not applicable)

Are you a visitor or contractor?

If you are a contractor, enter company name

Answer each of the following questions.

Have you been diagnosed with COVID-19 within the past 14 days?

Do you currently have, or have you recently had, symptoms of COVID-19, such as fever, cough, shortness of breath or difficulty breathing, chills, repeated shaking with chills, muscle pain, headache, sore throat, new loss of taste or smell?

Have you had a recent potential exposure to COVID-19, such as: (a) a household member or intimate partner with COVID-19; (b) providing in-home care for a person with COVID-19 without using recommended infection control precautions; (c) direct contact with a person with COVID-19; or (d) close contact (less than six feet) with a person with COVID-19 for longer than a few minutes?

REVIEW THE FOLLOWING INFORMATION

If you responded YES to any of the above questions, access to campus is not authorized unless you meet the following conditions for authorized access:

•     •Anyone with COVID-19 signs or symptoms must not visit campus until they satisfy all of the conditions in one of the following scenarios:
  •         -10 days since symptoms first appeared and 24 hours with no fever without the use of fever-reducing medications and other symptoms of COVID-19 are improving*
  •         -If the person's healthcare provider recommends testing for COVID-19, the healthcare provider will let the person know when isolation ends based on the individual's test results.
      *Loss of taste and smell may persist for weeks or months after recovery and need not delay the end of isolation.
•     •Anyone who has tested positive for COVID-19 but does not have any symptoms must not visit campus until at least 10 days have passed since the date of the first positive test and they continue to have no symptoms since the test.
•     •Anyone who has tested positive for COVID-19 AND had any symptoms of illness must not visit campus until at least one day has passed without a fever (without the use of fever reducing medicine) and symptoms have improved and at least 10 days have passed since symptoms first appeared.
•     •Anyone with a potential exposure to COVID-19 is not authorized to visit campus until 14 days have passed since the last potential exposure.

If you responded NO to all of the above questions (or if you responded YES to any question and you meet the conditions for authorized access set forth above, as applicable), please read and submit the certification below.

READ AND SUBMIT THE CERTIFICATION.
By submitting this questionnaire below, you certify that your responses to the above questions are true, you meet the all of the conditions for authorized access to campus set forth above (as applicable), and that you will comply with the precautions for preventing the spread of COVID-19 as required by the University, including the following:

•     •Do not visit the University's campus if you have (or recently had) signs or symptoms, a diagnosis, or potential exposure to COVID-19 unless you meet the above criteria for authorized access to campus.
•     •Wear a cloth face covering or a disposable, multi-use mask and keep a social distance of at least 6 feet at all times while on campus.
•     •Wash your hands frequently for at least 20 seconds, especially after coughing, sneezing, using the bathroom, or touching items in a public space. Use hand sanitizer if soap and water is not available.
•     •Avoid touching your face. Also avoid touching all high-touch surfaces. If this cannot be avoided, wash your hands immediately afterward.
•     •The University requires compliance with all COVID-19 precautions recommended by the CDC or required by local government/public health officials. COVID-19 precautions must be taken at all times while on campus no matter how many people are on campus.
•     •Visitors who experience signs or symptoms of COVID-19 while on campus must report that fact to Interim Police Chief Kevin Koo at 513-244-4226.
•     •Employees who have signs or symptoms, a diagnosis, or a potential exposure to COVID-19 must report that fact to Director of Office of Human Resources Lisa Kobman at 513-244-4979.
•     •Students who have signs or symptoms, a diagnosis, or a potential exposure to COVID-19 must report that fact to report to Health Services Manager Amy Demko at 244-4408.