COVID-19 Reporting Worksheet 2024-25

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Please submit one form for each student. If there is a required answer and it does not pertain to you, please write N/A. Complete this form to submit your notification of a positive COVID test. Your information will be kept confidential. Thank you for helping to keep our SBS community safe.

Email *

Student Name: *

Student Birthdate *

YYYY

Student's Grade and Attendance Room Teacher: *

TK - Miss Vander Riet

TK - Miss Carey

Kindergarten - Ms. Skifstrom

Kindergarten - Mrs. Ourique

Grade 1 - Mrs. Salcedo

Grade 1 - Mrs. Nosek

Grade 2 - Mrs. Hernandez

Grade 2 - Miss Scharf-Valdez

Grade 2- Mrs. DeYoung

Grade 3 - Mrs. Lewis

Grade 3 - Mrs. Dixon

Grade 4 - Mrs. deHeras

Grade 4- Mrs. Filipan

Grade 5 - Miss Nguyen

Grade 5 - Mrs. Jojola

Grade 5 - Ms. Wittels

Grade 6 - Mrs. Bruno (Attendance Room)

Grade 6 - Mr. Napoli (Attendance Room)

Grade 7 - Mrs. Swann (Attendance Room)

Grade 7 - Mrs. Chapdelaine (Attendance Room)

Grade 8 - Mrs. Jones (Attendance Room)

Grade 8 - Mrs. Wysokinski (Attendance Room)

Other:

Required

Form Completed By - Parent Name: *

Phone Number: *

Form Instructions and Agreements
*

By checking this box, I acknowledge and agree to follow the instructions noted above.

Required

Recommendations for People Who Test Positive (Symptomatic or Asymptomatic)

1. Stay home if you have COVID-19 symptoms, until you have not had a fever for 24 hours without using fever reducing medication AND other COVID-19 symptoms are mild and improving.If you do not have symptoms, you should follow the recommendations below to reduce exposure to others.

2. Wearing masks when you are around other people indoors is highly recommended for the 10 days* after you become sick or test positive (if no symptoms). You may remove your mask sooner than 10 days if you have two sequential negative tests at least one day apart. Day 0 is symptom onset date or positive test date.

3.Avoid contact with people at higher-risk for severe COVID-19 for 10 days*. Higher-risk individuals include the elderly, those who live in congregate care facilities, those who have immunocompromising conditions, and that put them at higher risk for serious illness.

4.Seek Treatment. If you have symptoms, particularly if you are at higher risk for severe COVID-19, speak with a healthcare provider as soon as you test positive. You may be eligible for antiviral medicines or other treatments for COVID-19. COVID-19 antiviral medicines work best if taken as soon as possible, and within 5-7 days from when symptoms start.

Call 1-833-422-4255 if you are unable to contact a healthcare provider, or use the treatment options to find one.

*The potential infectious period is 2 days before the date of symptoms began or the positive test date (if no symptoms) through Day 10. (Day 0 is the symptom onset date or positive test date).

Please list all siblings that attend St. Bonaventure School (include teacher's name and grade level. i.e., John Smith- Ms. Rivera 8th-grade). *

Has the student displayed symptoms? *

Yes

Required

Onset Date of Symptoms:

YYYY

Student Symptoms: Please check all that apply. *

Fever (at or above 100)

Congestion/Runny Nose

Nausea/Vomiting/Diarrhea

Sore Throat

Headache

Fatigue/Muscle or Body aches

Cough

Difficulty Breathing

Loss of Taste/Smell

None of the Above/No Symptoms

Other:

Required

Test Date: *

Test Result: *

Positive

Negative

Required

Last day student attended school in person? *

YYYY

Does the student participate in the Extended Day Program? *

Yes

Required

How often do they attend Extended Day?

Last day student attended the Extended Day program?

YYYY

Does the student participate in any school related after-school sports or clubs (team sports, cheer, etc.)? Please list: *

Is there any other information you would like to provide?

OCHCA COVID Symptoms

OCHCA COVID Definitions

Acknowledgement: *

By checking this box, I acknowledge that I have read the OCHCA COVID Symptoms, Recommendations for People Who Test Positive (Symptomatic or Asymptomatic), and Definitions provided above.

Required

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