In keeping the the state's COVID-19 protocols for schools, the school administration is responsible to maintain a list of names of students, teachers, and other employees who are at higher risk for severe illness from COVID-19.  

The reason for collecting these names is that officials from the Utah County Health Department will directly contact the parents of students, teachers, or employees who are at higher risk in the event of possible COVID-19 exposure and provide guidance on how long they should quarantine, how to check for symptoms, and when to consider testing.  

By maintaining a list of higher risk individuals, the school administration can evaluate which high risk individuals may have been exposed to COVID-19 through contact tracing and provide these names to the health department for contact and follow-up.  

Students and employees that have one of the above conditions OR that have been deemed high risk by their medical provider should complete this form.  Your information is safeguarded by state and federal privacy laws and will be kept confidential.  Use of this information will only be by the school administration, designated Point Of Contact (POC) personnel, and Health Department officials.

Click the next button to enter your information.