USE THIS FORM TO REPORT ANY SENECA EAST STUDENT WHO HAS COVID-19 POSITIVE DIAGNOSIS
Seneca East is required to report all positive COVID-19 cases to the community and the county health department. The student's personally identifiable information will be shared with staff members who have a need to know, but will not be shared with the community at large. The community will be informed of a positive COVID-19 case within our student body or staff but the community will not be provided with information that would identify the student or staff member.
Name of Student who has a confirmed Positive COVID test.
Name of parent or guardian completing this form.
Please provide a phone number where you can be reached.
Please provide an email address where you can receive communication.
Have you been in contact with a County Health Department?
Clear selection
What is the student's county of residence?
Submit
Never submit passwords through Google Forms.
This form was created inside of Seneca East Local School. Report Abuse