ICAGeorgia Parent COVID-19 Reporting Form (SY21-22)
Dear ICAGeorgia Parents or Guardians:

All ICAGeorgia staff and Students are required to report (1) a confirmed positive case of COVID-19 (2) a pending COVID-19 test result (regardless of the reason for the testing) and (3) a direct contact with a person who is COVID-19 positive.

Please fill out this form for your student ONLY if she/he meets one or more of the above 3 criterias.

● ICAGeorgia employees and students must notify school officials in writing immediately to make the above COVID-19 report.
● To report each case please, complete this online survey and email reportcovid19@internationalcharteracademy.org
● Reporting staff and students must wait for further guidance from the ICAGeorgia’s Principal and School Nurse after submitting a report; do not report to the school if you have tested positive.
● Employees and visitors are not to report to the school if they feel ill or have symptoms related to COVID-19.
● ICAGeorgia’s school nurse will investigate all reports in consultation with public health officials. Staff and students are required to cooperate with the Georgia Department of Public Health and the school nurse and respond truthfully to all questions.

NOTE: If your child received a Close Contact Notification from our school and waiting on the test result or received a test result, you do not need to fill out this form. Upon recieving the test result, please email it to reportcovid19@internationalcharteracademy.org.

DISCLAIMER: Please note you may be asked some sensitive health and personal questions in this form. This information may be transmitted and used by the Department of Public Health and ICAGeorgia or case investigation and contact tracing, reporting purposes, and any necessary follow-up from the school. However, the information is strictly confidential and exempt from disclosure under applicable law.


(1) 新型コロナウイルスの陽性が確認された場合、
(2) 新型コロナウイルスの検査結果が保留の場合(検査の理由に関わらず)、
(3) 新型コロナウイルス陽性者と直接接触した場合、報告する必要があります。


● ICAジョージアの教職員及び児童は、上記の新型コロナウイルスの報告をするにあたり、速やかに学校関係者へ書面にて通知してください。
● 報告の方法は、このオンラインアンケートに記入し、更にreportcovid19@internationalcharteracademy.org へEメールしてください。
● 報告後、学校長及びスクールナースからの次の指導をお待ちください。陽性反応が出た場合は、学校へ登校しないでください。
● 教職員及びビジターについては、体調不良や新型コロナウイルスの症状が出た場合、学校への訪問をしないでください。
● スクールナースは、公衆衛生当局と協議の上、全ての報告を調査します。教職員及び児童は、ジョージア州公衆衛生局とスクールナースに協力し、すべての質問に正直に答えることが求められます。


Email *
Are you a parent/guardian of a currently enrolled ICAGeorgia student? ICAジョージア在校生の保護者さまですか? *
Parent/Guardian's name 保護者名 *
Student Name 児童名 *
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