COVID/Illness Reporting Form - English
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You are not legally required to provide any private or confidential information regarding yourself. The district will use this information to provide supports to its employees and families. The information you provide may be used by district administration and the health services employees to assist its employees and families. Under state and federal law or court order, the district may be required to provide this information to those entitled to the information.
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Email *
Once you submit your information, you will receive an email with basic instructions (except for travel quarantines). If you do not receive an email, there was an error or you did not click submit. Please try again to ensure your data is collected.
Reporting: *
Building/Program: *
Name of Person Filling Out This Form: *
Your Phone Number (will be used for the school nurse to follow-up): *
May the school nurse leave a confidential voicemail at this number? *
May the school nurse send a confidential email to the address above? *
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