QAS COVID REPORTING FORM
Please fill this out from the viewpoint of the student. Please only fill this form out if the student has been exposed to a confirmed positive case. If you are simply reporting an absence please continue to complete the attendance form.

1. If your child has been exposed to a confirmed case of COVID-19 you must complete this form.

2. Keep your child home until you hear from the school office
Email address *
Student Last Name *
Student First Name *
Grade Level *
Homeroom Teacher *
Student Date of Birth *
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Last DATE student was in school *
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Home address *
Parent/Guardian phone number (best number to call) *
Name of person completing this form (First and Last name) *
Type of case *
Relationship of person who is positive:
If the positive person is in the household, will that person be in isolation (in a specific "sick room" away from everyone else, using a separate bathroom, and not sharing meals together?)
Clear selection
Does the positive person have symptoms? *
Does the student have symptoms?
Clear selection
What DATE did the positive person first have symptoms?
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What DATE was the positive person tested? *
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What DATE was the student exposed to the positive person? *
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Please describe details of exposure *
Submit
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