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2024/2025 ESMCSD After-Hours COVID 19 Hotline
This form is intended for reporting a Positive COVID-19 test.
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* Indicates required question
Email
*
Your email
Parent/Guardian or Staff Full Name
*
Your answer
Parent/Guardian or Staff Home Phone Number
*
Your answer
Parent/Guardian or Staff Cell Phone
Your answer
Student/Staff Full Name
*
Your answer
Student's Grade
*
Choose
K
1
2
3
4
5
6
7
8
9
10
11
12
NA (for staff reporting)
Student/Staff Building
*
Dayton Avenue School
South Street School
Tuttle Avenue School
Eastport Elementary School
ESM Jr-Sr High School
Siblings Names (if applicable)
Your answer
Siblings School(s) (if applicable)
Your answer
Date of Positive Test
*
MM
/
DD
/
YYYY
What was the date of first symptoms?
*
MM
/
DD
/
YYYY
When was the last day child or staff member was in school?
*
MM
/
DD
/
YYYY
Comments/Additional Information:
Your answer
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