Worthington Schools - COVID-19 Report
Si necesita ayuda para completar este formato de alguien que hable español, contacte a Sarah al email spettigrew@wscloud.org

Para ter ajuda completando este formulário em PORTUGUESE, por favor contatar Raul: rarias@wscloud.org

للمساعده باللغه العربيه يمكنك التواصل مع نهى احمد على nahmed@wscloud.org
Today's Date *
MM
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DD
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YYYY
Building (Check All That Apply) *
Required
If other, please indicate the building here:
Name of person filing report *
Position of person filing report
Phone number of person filling out report *
Are you reporting *
If it was a positive test, date of test results:
MM
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DD
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Name of individual *
Date of Birth of individual
MM
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DD
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YYYY
Address of individual
Phone number, email or other contact information for individual: *
Last day the individual was on property or in building *
MM
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DD
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YYYY
First day with symptoms
MM
/
DD
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YYYY
The individual is a *
If individual is a staff member, are they
Clear selection
Names of other Worthington staff/students living in the household:
Please provide any additional relevant information
Submit
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