Staff COVID-19 Reporting Form
In addition to completing this form, employees are required to also notify their immediate supervisor.
Best phone number to reach you?
Pampa High School
Pampa Junior High School
I have tested positive for COVID-19
I have symptoms that are reflective of COVID-19
Someone at my home has tested positive or has symptoms
I have had "close contact" or prolonged exposure with someone who has tested positive or has symptoms
Date of First Symptoms (if applicable)
Date of COVID-19 Test (if applicable or known)
Where / How do you believe this exposure occurred?
At work / work related capacity
Personal / Home
Date last on campus or with students or staff
Preliminary list of people you have had "close contact" with on your last date on campus and two (2) days prior to your first symptom. *Close contact is within 6 feet for 15+ minutes with no face covering or exposed to secretion (cough, sneeze, etc.)
Thank you for completing this form. Please follow all of the "Return-to-Work" protocols. The general guidance for returning to work when you have had close contact is 14 days of self-quarantine. It is recommended that you contact your primary care physician. For employees who have symptoms or test positive, they may return to work after 10 days have passed from symptom onset and at least 24 hours have passed with no fever, without the use of fever-reducing medication and the individual has improvement with all other symptoms.
For questions about leave, please contact Dr. Abigayle Barton at
For questions about return-to-work guidelines, please contact Stuart Smith at
Please let us know how we can support you during this time.
Send me a copy of my responses.
Never submit passwords through Google Forms.
This form was created inside of Pampa ISD.