Crisis Team Notification Form

The details provided will be treated as strictly confidential and are required for consulting with the Gesundheitsamt (Public Health Office). Above all, they can help to define necessary measures in the respective organisational unit without affecting or having to completely close down operations for the whole University.

Please fill in these sections of the form » Contact to persons suffering from COVID-19 » Period of stay in an international risk area prior to arrival in Wismar or Warnemünde » COVID-19 symptoms » Confirmed case of COVID-19

Crisis Team Notification Form

1. Personal Details

First of all, please provide your personal details.

Please note:
Boxes marked with a * are mandatory.

Which status group do you belong to?


2. Information about recent contacts

In the last 14 days, I have ...


3. Information about your state of health

In the last 14 days, I have ...


4. Information regarding arrival from international risk areas

In the last 14 days, I have ...


NOTE

Please also read the current instructions on our coronavirus information page.


5. Further details