Pine Ridge Middle School COVID-19 Reporting for Students/Staff
Thank you for reporting a close contact, a household contact, symptoms, or a positive case of COVID-19.
Parents: The School Nurse will contact you regarding your child's return to school date.
Staff: Please notify your administrator regarding your return to work and follow guidance at the end of this survey.
You will be asked which one of these you will be reporting:
Close Contact (within 6ft for a cumulative of 15 minutes of a positive case of COVID-19)
Household Contact (student or staff lives with a person who has tested positive for COVID-19)
Positive (student/staff tested positive for COVID-19)
Symptoms: One of these: Fever (temp 100.4 or greater), Shortness of breath or difficulty breathing, Loss of taste or smell, New or worsening cough OR other symptoms associated with COVID-19: Sore throat, Headache, Chills, Nausea or vomiting, Muscle or body aches, Congestion or runny nose, Fatigue, Diarrhea
Please choose from the following:
First Name of Student or Staff:
Last Name of Student or Staff:
Date of Birth of student or staff:
School or District Location:
For follow up, indicate your preference of how you would like to be contacted:
Phone or Email
Best Phone Number to Reach You:
Email address (list "none" if none available):
What are you reporting?
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This form was created inside of Lexington County School District Two.