Preliminary COVID-19 Screening Form (for UTRGV employees)

Note: This form is directed to UTRGV employees (faculty, staff, student-employees) who have symptoms of COVID-19, know that you were exposed to someone with COVID-19, or have been tested for COVID-19. If you are a student (non-employee), please contact Student Health Services in Brownsville at (956) 882-3896 and in Edinburg at (956) 665-2511. Visitors should contact their health care provider.

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Employee Information
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Employee Status
What is your employee status? (Required)





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Campus Location
Where are you located on campus? (Required)




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Supervisor Information
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Other questions
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Were you in close contact with UTRGV staff, faculty or students 2 days prior to symptoms?

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