AUSD Health Services - COVID-19 Support
Please complete this form to report a positive COVID-19 case, a COVID-19 exposure, or symptoms concerning COVID-19. This form will provide specific feedback and information based on your responses, including next steps and return-to-school timelines.

请填写此表格以报告 COVID-19 阳性病例、COVID-19 暴露或有关 COVID-19 的症状。此表格将根据您的回答提供具体的反馈和信息,包括后续步骤和返校时间表。

Complete este formulario para informar un caso positivo de COVID-19, una exposición a COVID-19 o síntomas relacionados con COVID-19. Este formulario proporcionará comentarios e información específicos basados ​​en sus respuestas, incluidos los próximos pasos y los plazos de regreso a la escuela.

Sign in to Google to save your progress. Learn more
Email *
First Name *
First name of student or staff impacted by COVID/other illness
受 COVID/其他疾病影响的学生或教职工的名字
Nombre del estudiante o personal afectado por COVID/otra enfermedad
Last Name *
Last name of student or staff impacted by COVID/other illness
受 COVID/其他疾病影响的学生或教职工的姓氏
Apellido del estudiante o personal afectado por COVID/otra enfermedad
Phone *
Please provide a phone number where you can be reached.
请提供可以联系到您的电话号码。
Proporcione un número de teléfono donde se le pueda localizar.
School/Work Location *
Select your primary site or the site where you are next scheduled to report
选择您的主要站点或您下一次计划报告的站点
Seleccione su sitio principal o el sitio en el que está programado para informar próximamente
This form is being filled out for *
正在填写此表格
Este formulario se está completando para
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of AUSD. Report Abuse