Sandlapper's After Hours COVID-19 Reporting
Please complete this form if you are reporting symptoms of Covid-19, Close Contact with someone who tested positive for Covid-19 IN or OUT of your home and/or a POSITIVE Covid-19 test.
After you fill out this form, I will contact you to go over details and education at the next business morning if it is after hours. If you want to leave more information, contact me at 803-691-4045 ext 29010 or alcarter@richland2.org.
Your email address will be recorded when you submit this form.
Thank you,
Alice Carter, RN
Sign in to Google to save your progress. Learn more
Email *
Email address * *
Student/Employee Legal Last Name *
Student/Employee Legal First Name *
Phone number where you may be reached (with area code). *
Date of Birth *
MM
/
DD
/
YYYY
Are you a parent reporting for your child or a teacher reporting for yourself? * *
Parent's Name *
Grade *
Are you reporting that you are positive or a close contact? * *
Reported symptom(s) *
When did the Symptom Begin?
MM
/
DD
/
YYYY
When did you test Positive?
MM
/
DD
/
YYYY
Where did you get tested?
Please list the name(s) and school(s) below for any other children residing in the home that attend Richland Two Schools?
Please list the name(s) and school(s) below for any other Adults residing in the home that Work in Richland Two Schools?
Is your child a Car Rider or in a Car Pool with other students? Enter students in the car pool on the "Other" line. *
Is your child a Bus Rider? *
Is your child in aftercare at the school? *
Is your child involved in any after-school sponsored activities, e.g. sports, band, JROTC, clubs, etc.? Please list them on the line below
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of richland2.org.

Does this form look suspicious? Report

Google Forms