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COVID-19 Positive or Close Contact Report
Parents- please complete this form and a nurse/ contact tracer will contact you about the length of quarantine.
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* Indicates required question
Email
*
Your email
Student's Name
Your answer
Date of Birth
MM
/
DD
/
YYYY
Teacher Name
Your answer
Parent Name
Your answer
Parent Email
Your answer
Parent Phone Number
Your answer
Has the student been in close contact with a positive COVID-19 case or has the student received a positive COVID-19 test?
Close Contact
Positive for COVID-19
Clear selection
Date the student was last at school
MM
/
DD
/
YYYY
Close Contact: Date of last contact with the COVID positive person
MM
/
DD
/
YYYY
COVID Positive: Date of Positive Test
MM
/
DD
/
YYYY
Date Symptoms started (if symptomatic)
MM
/
DD
/
YYYY
If your child is a bus rider, please list the bus number
Your answer
Are there any other close contact you are aware of?
Your answer
Are there any other family members in CCSD? If so, please list their name and school.
Your answer
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