This form is designed to collect information from Breakthrough Public Schools employees or contracted staff who:
1.Have tested positive for or received a confirmed diagnosis of COVID-19
2. Are experiencing COVID-19-like symptoms
3. Have known close contact with an individual who has tested positive for COVID-19. ("Close contact" with someone with COVID-19 is defined as being within 6 feet of that person for at least 15 minutes within 48 hours of symptom onset, while UNMASKED.)
Please ONLY complete this form if you meet the criteria listed above.
All other questions and comments can be submitted via email to email@example.com
Note that all information submitted through this form will be kept confidential. No identifying information will be shared outside of HC or the Operations leadership team without your express written permission.