CCSD - COVID-19 Case / Close Contact Report for Winterville Staff

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Dear Clarke County School District Employee,

If you have received a positive COVID-19 test or have been in close contact (less than 6 feet of space for more than 15 minutes) with someone who has COVID-19, please complete the information below. This is an important step in helping us identify COVID-19 cases and reduce exposures and viral spread within our school communities. Please know that your information will be kept confidential and will only be shared with the school nurse and your principal/supervisor. Depending on your answers, the information may be shared with the local DPH (department of public health) who may follow-up with you for community contact tracing purposes. Your public health participation will benefit everyone as we move forward in the school re-entry process.

You will be contacted by HR regarding the date that you are approved to return to work, pending symptoms and/or test results as recommended by DPH. Please contact your school nurse or HR representative for additional questions.

Email *

I am sharing that *

I received a positive COVID-19 test result.

I have been in close contact with someone who received a positive test result (less than 6 feet for more than 15 minutes)

I have COVID-19 symptoms but have not been tested yet.

I have been tested for COVID-19 and am awaiting test results.

Other:

Please share your first and last name. *

Please share a phone number where you may be reached. *

Date of birth

YYYY

Covid Test Date

YYYY

Covid Test Result - Please email test result to covid19results@clarke.k12.ga.us *

Positive

Negative

Results Pending

I have not had a covid test

If you have a positive COVID-19 test, check which symptoms you have.

I do not have symptoms

Fever greater than 100.4 F

Unexplained cough unrelated to allergies or an underlying medical condition

Unexplained nasal congestion or runny nose unrelated to allergies or an underlying medical condition

Unexplained shortness of breath or difficulty breathing

Unexplained headache, muscle aches or body aches

New loss of taste or smell

Fatigue

Unexplained nausea or vomiting

Diarrhea

Other:

Please list the names and phone numbers of individuals with whom you have had close contact (if symptomatic, please start two days prior to symptom onset & if asymptomatic, please start two days prior to COVID-19 test administration). Please remember that a close contact is defined as someone you have been within 6 ft of for 15 minutes or longer. If you are concerned about other possible exposures or are uncertain if someone is a "close contact" or not, please list their name and the school nurse will follow up with you for more details.

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