JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
STAFF Reporting COVID-19 Positive Status
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
School/Location (Check all that are appy)
*
Dutch Neck Elementary School
Maurice Hawk Elementary School
Town Center Elementary School
Wicoff Elementary School
Millstone River School
Village School
Community Middle School
Grover Middle School
High School North
High School South
505 Village
Central Office
Required
What is your position/working assignment for WW-P
*
General education teacher
Special education teacher
Special education other certificated role (OT/PT/CST)
Special area teacher
Teacher Resource Specialists/Tech Resource Specialists
Secretary
Administrator
Special education instructional assistant
Cafeteria, bus, or playground aide
Bus driver
Buildings and Grounds
Other:
Today's Date
*
MM
/
DD
/
YYYY
Reason for concern
*
Positive COVID-19 test result (PCR or Rapid Test)
Positive COVID-19 test result (Home Test)
If symptomatic, date symptoms began
MM
/
DD
/
YYYY
If a COVID test has been conducted, what was the date of the test?
MM
/
DD
/
YYYY
Last date physically present in District
*
MM
/
DD
/
YYYY
Email address of building principal
Your answer
Email address of supervisor
Your answer
Best phone number to reach you (###) ###-####
*
Your answer
Best email address to reach you
*
Your answer
Any additional pertinent information
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of West Windsor-Plainsboro Regional School District.
Report Abuse
Forms
