Positive Covid-19 Self-Report Form
Please fill out the form below to report a confirmed Covid-19 case. If reporting more than one case, please complete the form separately for each individual positive case. This form will only be shared with RSD 13 Covid Liaison, Pamela Branciforte, and designated administration for purposes of contact tracing.

All fields are required.
Email *
Your email *
Name of Student/ Staff Member testing positive *
School or School Location *
Grade or School Position *
Last Date Present in Building *
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Date Symptoms Started
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Please list symptoms present. If no symptoms, please type none. *
Date Positive Covid Test was Taken *
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Telephone Number to Reach Reporter *
Reporter's Name and Relationship to the Individual Testing Positive *
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