COVID-19 Reporting
When reporting a positive COVID-19 case, please complete all areas of the form.  A CDSD employee will contact you to confirm receipt of the completed form.  
Sign in to Google to save your progress. Learn more
Email *
Student's First and Last Name *
Guardian's First and Last Name *
Guardian's Phone Number *
School Student Attends *
Date of Positive COVID-19 Result *
MM
/
DD
/
YYYY
Is the student *
If symptomatic, on what date did symptoms begin?
MM
/
DD
/
YYYY
What is the last date the student was present in the school building?
MM
/
DD
/
YYYY
Does the student participate in CDSD extra-curricular activities that are currently meeting in-person? *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Central Dauphin School District. Report Abuse