Student/Staff/Parent Contact Form for Positive COVID Case Outside School Hours
This form is for individuals who have had a positive test result to complete if it is outside normal school hours. Please complete this form if you are a staff member who has received a positive COVID result or the parent of a student and either you or your student has tested positive.

If it is during school hours, please contact your student's school nurse.
ECC - 380-4421, ext. 2230
HES - 380-4131, ext. 3230
McEowen- 380-4545, ext. 4230
HMS - 380-7654, ext. 5230
HHS - 380-3273, ext. 6230
CCC - 380-3253, ext. 7301
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Student/Staff Name
Building
Student's Teacher(s)
What day did the individual take the test?
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DD
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YYYY
What day did you get the results?
MM
/
DD
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YYYY
Has the individual had or currently have any of the following COVID symptoms? (check all that apply)
Date of onset of symptom(s) if applicable
MM
/
DD
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YYYY
Has the health department contacted you about your student isolating or quarantining?
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What date did the health department indicate was the individual's last day of quarantine or isolation?
MM
/
DD
/
YYYY
Individual completing this form
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