Please fill in the form below to open a new ticket.
Preferred method of contact should the college need to reach you.
Complete all required fields to request Access to Chesapeake College.
If you are Visitor, please state the purpose/reason for visit.
Are you currently experiencing, or have you experienced in the past 14 days, any of the following symptoms?
Sudden recent loss of smell or taste
Fever (100.4° F / 38° C or greater) and/or Shaking Chills
Difficulty Breathing / Shortness of Breath
Either new, or different than your usual cough
Unusual muscle or body aches
Unrelated to Seasonal Allergies
Please enter any additional comments regarding your symptoms.
If you have any of the symptoms listed, please complete the following questions.
Have you been vaccinated against the flu?
Did you start getting sick in the last week?
Have you been in close contact with anyone with COVID-19 or a flu-like-illness?
By submitting this ticket request, you hereby certify that the responses provided above are true and accurate to the best of my knowledge.
(Note: The information collected on this form will be used to determine only whether you may be infected with COVID-19. The information on this form will be maintained as confidential. Any questions should be directed to your manager or your human resources representative.)