AUSD Health Services - COVID-19 Support

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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.

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

Student

Staff

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