Employee COVID-19 Case Report

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2022-2023

The purpose of this form is to report a staff member's confirmed case of COVID-19 or a staff member who has had a school age child excluded by the school for a COVID-19 related reason.

A Confirmed Case is a situation in which you have been tested for COVID-19 and received a positive result.

Supervisor *

Name of the person filling out the form *

Contact phone number *

Contact email *

Select your situation *

I have a confirmed case of COVID-19 based on a positive test result.

I have a school age child who has been excluded by his/her school for a COVID-19 reason.

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