COVID Questionnaire

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COVID Questionnaire

Please complete this form if your child has a confirmed positive case or has been exposed to someone who is confirmed to have covid.

Email *

Parent/Guardian Name *

Parent/Guardian Primary Phone *

Parent/Guardian email *

Child's Name *

Child's Grade *

Option 1

Child's Teacher *

Question 1: Does this student have a confirmed case of COVID-19? *

Yes

Unknown

Question 2: If this student has a positive case of COVID-19, did the student have a PCR test? If no, skip to question #5.

Yes

Clear selection

Question 3: If you answered "yes", when was the PCR test taken?

YYYY

Question 4: What date were the PCR results confirmed?

YYYY

Question 5: Did this student have a rapid test?

Yes

Clear selection

Question 6: If you answered "yes", when was the rapid test taken?

YYYY

Question 7: If your student is symptomatic, when was the symptom onset date?

YYYY

Question 8: If your child was exposed to someone with confirmed Covid-19, what was the exposure date?

YYYY

Question 9: What location was your child exposed to someone with covid?

Home

School

Other

Clear selection

Question 10: Is your child vaccinated?

Yes

Clear selection

Question 11: What day was this child last in school?

YYYY

Question 12: Is the child still in contact with someone with confirmed covid? (e.g., the close contact is someone in the household)

Yes

Clear selection

Who needs to quarantine or isolate?

Unvaccinated individuals, or fully vaccinated individuals who are eligible for the booster but haven’t received it yet, who were recently exposed to COVID-19, should follow quarantine procedures. Exposed individuals may become ill or infectious with COVID-19 between two and 14 days after their last exposure to the virus. It is possible to be infectious with COVID-19 without feeling ill.
People who were exposed to COVID-19 less than 14 days after receiving their final dose of the COVID-19 vaccine should follow quarantine procedures.
People who become sick or develop symptoms following an exposure to COVID-19 should follow isolation procedures and seek testing.
Individuals are recommended to quarantine for five days after their last exposure, and wear a mask in public for the following five days.
Get tested for COVID-19 five days after your exposure or as soon as you experience symptoms, preferably with a PCR test. 
How long you should isolate depends on whether or not you feel ill.

If you have symptoms, isolate yourself from others until:

You have no fever and resolving symptoms for 24 hours without the use of medicine, AND 
At least five days have passed since your first symptoms 

If you don’t have symptoms, isolate yourself from others until:

Five days have passed since your test, and you have no symptoms. If symptoms begin, isolate following the above criteria.
You should continue to wear a mask when around others for five days after your isolation period ends.

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