Covid 19 Positive Case Form
Student Surname *
Student First Name *
Student Date of Birth *
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Gender *
Year Group *
Form Group *
Date symptoms started *
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DD
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YYYY
Last day in school *
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DD
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Date test taken *
MM
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DD
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YYYY
Date of positive covid test *
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DD
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YYYY
Close Contacts
Your child has been within 1 metre for more than a minute with a person

Your child has has been within 2 metres for 15 minutes or more with a person

Your child has sat next to somebody in a lesson

Your child has shared a car with a person

List the students/teachers the positive case was in contact with 48 hours before symptoms OR 48 hours before test date if asymptomatic (eg. symptoms showing on Wednesday, who were the contacts on Monday?) *
List the students/teachers the positive case was in contact with 24 hours before symptoms OR 24 hours before test date if asymptomatic (eg. symptoms showing on Wednesday, who were the contacts on Tuesday?) *
List the students/teachers the positive case was in contact with on day of symptoms. (eg. symptoms showing on Wednesday, who were the contacts on Wednesday?) *
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