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
I am completing this form...
As a staff member who tested positive
For my child/student who tested positive
As a parent who tested positive
Clear selection
Student/Staff Name
Your answer
Building
Harrisonville Early Childhood Center
Harrisonville Elementary School
McEowen Elementary School
Harrisonville Middle School
Harrisonville High School
Wildcat Academy
Cass Career Center
Student's Teacher(s)
Your answer
What day did the individual take the test?
MM
/
DD
/
YYYY
What day did you get the results?
MM
/
DD
/
YYYY
Has the individual had or currently have any of the following COVID symptoms? (check all that apply)
New cough
Loss of taste/smell
>100.4 F fever
Congestion/runny nose
Nausea/vomiting/diarrhea
Sore throat
Headache
Body aches
Difficulty breathing
No symptoms
Date of onset of symptom(s) if applicable
MM
/
DD
/
YYYY
Has the health department contacted you about your student isolating or quarantining?
Yes
No
Clear selection
What date did the health department indicate was the individual's last day of quarantine or isolation?
MM
/
DD
/
YYYY
Individual completing this form
Your answer
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