Positive COVID-19 Case Reporting
Please complete this form to help us gather data around students who test positive for COVID-19 as a result of out of school testing. Sharing this information will allow us to identify school based close contacts. This information will only be shared with the school administration.
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Student Name
Student Grade
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Parent/Guardian Name
Parent/Guardian Phone Number
Type of Test
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Date of Positive Test Result
MM
/
DD
/
YYYY
Date Symptoms Started
MM
/
DD
/
YYYY
Other Information: Please use this space to share any additional information you would like for us to know.
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