Chelsea High COVID-19 Self Reporting Form

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Please complete this form if you have been diagnosed with a positive COVID-19 test. Please plan on staying home for 5 full days from symptom onset. If you had no symptoms, then 5 full days from the date you tested positive. Only return to school/work if you are feeling at least 50% better and have had no fever for 24 hours. We recommend wearing a mask for 5 more days after your return to protect others.
Please email your local school nurse if you need guidance on when to return to school/work.
Thank you

Email *

Last Name *

First Name: *

I am a: check all that apply *

Sub or volunteer

Student

Teacher (para)

Coach/Extra curricular sponsor

Bus driver, aide or bus nurse

other support staff (admin, district personnel, etc.)

Required

Date of first symptom of Covid-19 (leave blank if asymptomatic):

YYYY

If you had no symptoms but tested positive, the date you were tested:

YYYY

I am a case that: *

was not tested and did not see a DR but was presumed positive based off of symptoms and an exposure to a known case

had a positive test (home, rapid or a PCR)

told by a Dr that I was positive but I was not tested

have a new loss of taste or smell

Send me a copy of my responses.

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