PUSD COVID Reporting
Please answer the following questions to help us support you/your child in next steps and the timeline for return to school.  Be sure to report your absence to your school or site as you would for any illness.  A member of our health staff will follow-up with information. 
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Contact email
First Name (of person with positive result) *
Last Name (of person with positive result) *
Student or Staff? *
PUSD School/Site- Check all that apply *
Required
Grade Level in (student) or in contact with (staff) *
Required
Positive Person Date of Birth
MM
/
DD
/
YYYY
When did symptoms consistent with COVID-19 FIRST appear?
MM
/
DD
/
YYYY
When was this person last on campus? *
MM
/
DD
/
YYYY
When did this person test positive for COVID-19? *
MM
/
DD
/
YYYY
If you are filling this form out on behalf of someone else, please provide your name here—and relation to patient—so we can contact you if needed.
A good contact number to reach you at?
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