Report Suspected or Confirmed COVID - RSU #34
For staff, students, households of the RSU #34 community. Please use this form to report confirmed or suspected cases of COVID19. If you or your household members have symptoms of COVID-19, please also check with your primary care provider.
Staff check this form frequently throughout the week to take appropriate follow-up action, in order to keep the spread of COVID-19 slow!
Who is completing this form? *
What is your phone number?
What is your email address?
Who is the person with either confirmed or suspected COVID? *
Please list any contact info that would help us get in touch with that person (phone number, email address)
In which of our schools does that person learn/work?
If you know it, please share the date of birth of the person with confirmed or suspected COVID:
If you know it, please share the town of residency of the person with confirmed or suspected COVID:
Is there any other information you can provide to help us follow up?
Please click "Submit" below.
Submit
Never submit passwords through Google Forms.
This form was created inside of RSU #34. Report Abuse