Middle and High School STUDENT - COVID Reporting Form
This form should be used by parents and guardians to report any and all student issues related to COVID. Once you complete the form you will be contacted by a School Nurse within 24 hours of completing this form during the week, and on Monday if this form was completed during the weekend.

If your child has tested positive, is awaiting test results, or has been exposed to this virus DO NOT send your child to school until he or she has been cleared to return by the school nurse and an attestation form has been completed. You will need to report your child's absence in addition to completing this form.

You can update the RI Department of Health on your child's status and schedule testing for your child by calling: 1-844-857-1814
Email address *
Student LAST Name, First Name *
Student date of birth *
MM
/
DD
/
YYYY
Location: name of school *
Classroom Teacher Name *
Does the child have any siblings other relatives/children living in the house that attend Warwick Public Schools? If Yes please complete a form for each child. *
If YES to the question above please give sibling name, grade and school attending *Please complete a form for each child*
Parent Name *
Parent Contact Info: home, cell, or work phone numbers *
COVID Status (check all that apply) *
Required
COVID Rapid Test Positive Date (if known)
MM
/
DD
/
YYYY
COVID PCR Test Positive Date (if known)
MM
/
DD
/
YYYY
Date of close contact of COVID positive person
MM
/
DD
/
YYYY
If student is symptomatic, please check all the apply
Date of first symptoms
MM
/
DD
/
YYYY
Last date in school (in person) *
MM
/
DD
/
YYYY
If required to be in isolation by RIDOH, please indicate the start date
MM
/
DD
/
YYYY
Isolation by RIDOH end date
MM
/
DD
/
YYYY
If required to be in quarantine by RIDOH, please indicate the start date
MM
/
DD
/
YYYY
Quarantine by RIDOH end date
MM
/
DD
/
YYYY
If the student was a close contact (closer than 6 feet for more than an accumulated 15 minutes) of a positive case, is the person
Clear selection
Anticipated return to school date (leave blank if unknown)
MM
/
DD
/
YYYY
Is the student able to participate in Distance Learning during absence? *
As required, I have reported my child's absence to the school *
Additional Comments
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Warwick Public Schools. Report Abuse