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Jackson R-2 Employee COVID-19 Reporting
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Please type your first name.
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Your answer
Please type your last name.
*
Your answer
Please type your cell phone number in the space below. (xxx-xxx-xxxx)
*
Your answer
Please select your primary building. If you have a split building position please select both buildings.
*
Senior High School
RO Hawkins Junior High
Jackson MIddle School
East Elementary
Gordonville Elementary
Millersville Elementary
North Elementary
Orchard Elementary
South Elementary
West Lane Elementary
Support Services
Central Office
District-Wide
Required
What is your job title?
*
Your answer
Please select your date of exposure.
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MM
/
DD
/
YYYY
If you are showing symptoms, please describe the symptoms here.
Your answer
Please share any additional information you would like to share in the space below.
Your answer
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