Report COVID-19 Positive Case
Please use this tool to alert the Hopkinton Health Department if you or anyone in your household has tested positive for COVID-19 or you have been told to quarantine because you may have been exposed to someone that has tested positive.
* Required
Email address
*
Your email
Name of individual reporting?
*
Your answer
Phone number of Individual reporting?
*
Your answer
What is the full name and phone number of the case?
*
Your answer
If the case is symptomatic, what was the reported date of symptom onset? If case does not have any symptoms, what was the date of the test?
MM
/
DD
/
YYYY
Did the case work or attend school while they had symptoms?
No
Yes
Unknown
Clear selection
Did the case work or attend school 48 hours before symptoms onset or positive test date?
Yes
No
Unknown
Clear selection
In the 7 days prior to symptom onset or postive test date, did the case attend school, work, a large gathering or athletics?
Yes
No
Unknown
Clear selection
Is the postive case a student or staff member at Hopkinton Public Schools.
Staff, Remote
Staff, In-person learning
Student, Orange Cohort
Student, Green Cohort
Student, attend school full time
Clear selection
Submit
Never submit passwords through Google Forms.
This form was created inside of Town of Hopkinton, MA.
Report Abuse
Forms
