Centerville Schools COVID-19 Reporting
Any student, staff member or volunteer/visitor who has tested positive for COVID-19 or who has been in close contact with someone with COVID-19 (within 6 feet of an infected person for a total of 15 minutes or more over a 24-hour period) must stay home and complete the following form WITHIN 24 HOURS.

Once the form is received, a school nurse or staff member from our Student Services Department will provide isolation and/or quarantine guidance from Public Health - Dayton & Montgomery County.
Today's Date *
Name of person filing report: *
Phone number of person filing report: *
I am completing this form for a: *
Never submit passwords through Google Forms.
This form was created inside of Centerville City Schools. Report Abuse