Student COVID-19 Reporting Form
In addition to completing this form, parents/students are required to also notify their child's campus.
Name of Student
Name of Parent/Guardian making this report.
What is the best phone number for Pampa ISD staff to contact you?
Pampa High School/PLC
Pampa Junior High School
My child tested positive for COVID-19
My child has symptoms that are reflective of COVID-19
Someone at my home has tested positive or has symptoms
My child has had "close contact" or prolonged exposure with someone who has tested positive or has symptoms
Date of First Symptoms (if applicable)
Date of COVID-19 Test (if applicable or known)
Date last on campus or with other students or staff
Preliminary list of people your child has had "close contact" with on the last day he/she was on campus before the onset of symptoms. *Close contact is within 6 feet for 15+ minutes with no face covering or exposed to secretion (cough, sneeze, etc.)
Where / How do you believe this exposure occurred?
Personal / Home
Thank you for completing this form. Please follow all of the "Return-to-Work" protocols. The general guidance for returning to school when a students has had close contact is 14 days of self-isolation. It is recommended that the student's primary care physician be contacted. For students who have symptoms or test positive, they may return to work after 10 days have passed from symptom onset and at least 24 hours have passed with no fever, without the use of fever-reducing medication and and the student has improvement with all other symptoms.
For questions about return-to-school guidelines, please contact your child's school nurse or Stuart Smith at
Please let us know how we can support your child during this time.
Send me a copy of my responses.
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This form was created inside of Pampa ISD.