COVID-19 Reporting Worksheet
Please submit one form for each student. If there is a required answer and it does not pertain to you, please write N/A.

Complete this form to submit your notification of a positive COVID test test, a symptomatic individual, or known close-contact exposure.

Your information will be kept confidential. Thank you for helping to keep our SBS community safe.
Email *
Form Completed By - Parent Name: *
Phone Number: *
Home Address (Include City and Zip Code): *
Clear selection
Student Name: *
Student Birthdate *
MM
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DD
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Individual who has tested positive and/or is symptomatic: *
Required
Student's Grade and Attendance Room Teacher: *
Required
Has the individual displayed symptoms? *
Required
Onset Date of Symptoms:
MM
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DD
/
YYYY
Has the individual(s) been tested for COVID-19? *
Test Location (include complete address and phone number): *
Type of COVID Test?
Clear selection
Specimen Source: *
Test Date: *
Test Result: *
Important: Send a copy or photo of test results to: kwhite@stbonaventure school.org. *
Has your child been exposed to someone known to have COVID-19? If so, please explain. Include the date and circumstances of known exposure. *
Last day student attended school in person? *
MM
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DD
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YYYY
Does the student participate in the Extended Day Program? *
How often do they attend Extended Day?
Last day student attended the Extended Day program?
MM
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DD
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YYYY
Does the student participate in any school related after-school sports or clubs (team sports, cheer, etc.)? Please list: *
Does the student participate in any NON-SCHOOL related after-school sports, activities, or clubs (team sports, dance class, karate, cheer, etc.)? Please provide list: *
Does the student carpool with other non-family students to and from school? *
Last date your child carpooled with non-family students
MM
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DD
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Is there any other information you would like to provide?
Please review the OCHCA Student Symptom Decision Tree *
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