ST BRIGID'S RESPIRATORY SYMPTOM REPORTING

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Please fill in this form when your child presents with any respiratory illness. In addition to this form, if your child tests POSITIVE, please also phone or email the school office. The school email address will be monitored 7 days a week.

Name of Student *

Student's Class *

Kindergarten

Year 1

Year 2

Year 3

Year 4

Year 5

Year 6

Do they have respiratory / cold-like symptoms? *

Yes

What are the symptoms? (even mild ones) *

No symptoms - precautionary

No symptoms - someone else in our household has COVID-19

Headache

Fever

Sore throat

Runny or stuffy nose

Cough

Aches and pains

Fatigue

Shortness of breath

Diarrhoea

Nausea/vomiting

Conjunctivitis (eye infection)

Required

Which COVID-19 test has been done? *

RAT

PCR

Both

No test

What date did your child have the RA test or PCR test? *

YYYY

Result of the COVID-19 Test *

Negative

Positive

Pending

No test undertaken

I acknowledge that my child MUST NOT return to school if they still have even the mildest of respiratory symptoms, even if they have tested negative. *

YES

I acknowledge that I have informed the school that my child has tested positive or has respiratory symptoms and tested negative. *

Yes

No. Please do so ASAP

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