Terrell ISD COVID-19 Employee Health Reporting Form (effective 9/1/2020)
Please complete the form with as much information as possible.
* Required
Email address
*
Your email
Name of person completing form.
Your answer
Last Name of Employee confirmed, suspected, or exposed to COVID-19
*
Your answer
First Name of Employee confirmed, suspected, or exposed to COVID-19
*
Your answer
Department/Campus
*
Burnett
Long
Willie
Wood
GLA
Furlough
THS
TAEC
C&A
ABM/Custodial
Central Office Business Office
Central Office Communications
Central Office Human Resources
Central Office Leading & Learning
Central Office Maintenance
Central Office Police
Central Office Special Education
Central Office Student, Family, & Community Services
Central Office Student Nutrition
Central Office Technology
Central Office Other
Transportation
Other:
Street Address
*
Your answer
City
*
Your answer
Zip Code
*
Your answer
Employee Telephone Number
*
Your answer
Is the employee symptomatic or tested positive for COVID-19?
*
Yes
No
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