Symptoms of illness or COVID-19 Positive Case Reporting Form
In an effort to continue to make our schools safe during the pandemic, we ask that you fill out this form if your student is ill or has tested positive for COVID-19. Please fill this form out as soon as possible to help us ensure we begin the contact tracing process to keep other students safe as well as making sure your student has what he or she needs to learn from home if possible.
If you have multiple students who are ill or have tested positive, please fill out a form for each child.
Student Last and First Name
Parent/Guardian Last and First Name
Parent/Guardian Contact Information
Student School Building
Cooper Early Educations Center
Slate Creek Elementary
South Breeze Elementary
Walton Rural Life Center
Santa Fe 5/6 Center
Chisholm Middle School
Newton High School
My student is experiencing these symptoms:
Fever (100.4 or greater)
Shortness of breath or difficulty breathing
Muscles or Body Aches
New loss of taste or smell
Congestion or runny nose
Nausea or vomiting
What date did symptoms start?
What date was student's COVID test?
COVID test result?
Not back yet
Was your child exposed to COVID? If so, please list the name of the individual and date of exposure.
Please list any USD 373 STUDENT close contacts your student might have had starting two days before symptoms began. A close contact is someone who has been within six feet or less for more than 10 minutes (even with a mask on).
Please list any USD 373 STAFF close contacts your student might have had starting two days before symptoms began. A close contact is someone who has been within six feet or less for more than 10 minutes (even with a mask on).
If your student participates in an activity or athletics, which one does he or she participate in?
Does your student ride a bus?
OPTIONAL: Is there any other information you'd like to share or that we would need to know?
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This form was created inside of Newton Public Schools.