Nova North Illness and COVID-19 Exposure Form
INSTRUCTIONS:
1. Please call the attendance line at 303-347-5204 if your student is unable to participate in remote instruction.
2. Only complete this form if you are reporting an illness or a COVID-19 positive case/exposure.
3. Please complete a SEPARATE form for EACH student in your household.
4. For more information, please refer to the FAQ's: https://littletonpublicschools.net/covid-faqs-parents.
Student First Name *
Student Last Name *
Student Date of Birth *
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Which school does your student attend? *
What grade? *
Is your student experiencing any of the following symptoms? Check all that apply. PLEASE NOTE: Current guidance recommends a COVID-19 test if these symptoms last longer than 24 hours. For more information, including return to school guidelines, please refer the COVID-FAQ's for parents at https://littletonpublicschools.net/covid-faqs-parents *
Required
Does your student have any of the following symptoms? Check any that apply. PLEASE NOTE: Current guidance recommends a COVID-19 test if these symptoms last longer than 48 hours. For more information, including return to school guidelines, please refer the COVID-FAQ's for parents at https://littletonpublicschools.net/covid-faqs-parents *
Required
What date did the symptoms first begin?
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If your student has been or will be tested for COVID-19, indicate date of test.
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If a COVID-19 test was done, what were the results?
Clear selection
Has your student been exposed to a positive or potentially positive COVID-19 case? Close contact is defined as within a 6 foot distance for a cumulative time of more than 15 minutes. Exposure has to be after the close contact began showing symptoms or during the 2 days prior.
What was the last date of exposure (the last time your student was around a person with COVID-19)?
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If a health care provider or local public health department gave you a date to end quarantine or isolation, what was that date?
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If the School Nurse Consultant needs to contact you, please list the best phone number or email address. *
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