Contact Tracing
The purpose for this form is to protect the health and safety of all MBUSD employees. All MBUSD employees must fill out this form on a daily basis to help monitor employee interactions - the CDC guidelines tell us that we are at risk when we are less than six feet away from someone for more than 15 CUMULATIVE minutes (including while wearing a face covering) in a 24 hour period. You must fill out this form for each interaction you have that meet these requirements. We will refer to this information when an employee tests positive for COVID19 so that people who have been in close proximity with that person may self quarantine and get tested.
Email *
Name *
Your Site/Department *
Today's Date (Date of Interaction) *
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Check all sites that you visited in the last 48 hours (during the course of your work day):
Did you interact with anyone (within 6 feet for more than 15 CUMULATIVE minutes total) in person within the last 24 hours? This includes employees, parents, students, independent contractors, and anyone else with whom you've come into contact.
Clear selection
Length of Interaction
Clear selection
MBUSD site where interaction took place
Exact Location of Interaction (room number, office, room name, field area, etc). Be specific
Names of ANYONE with whom you were a close contact (employees, students, parents, vendors, independent contractors, etc.) Only list students if you see different students each day or different student groups on different days of the week.
List anyone with whom you've come in contact for LESS than 15 minutes that you would like to be notified if they became COVID positive.
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