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AWC Employee/NAU Branch Campus
Flu-Like Illness Tracking Form

It is necessary for Arizona Western College Health Services to track Flu-Like illness at all Campus and Learning Center locations to determine if our prevention strategies are adequate in minimizing infections.

Furthermore, it is important to provide the Yuma County Health Department, La Paz County Health department and the State of Arizona Health Department with all the necessary statistics on the epidemiological nature of the Flu virus. All information provided will remain as confidential as possible, while tracking this virus.

If you are experiencing symptoms of flu, please check the appropriate box(es) below:

  1. Enter your full name

  2. Enter your age:

  3. Enter your gender:

  4. I work for:

  5. I am experiencing the following Flu like symptoms:

  6. Date flu-like symptoms began:

  7. I work for the following department:

  8. I work at the following location(s):

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