Simsbury Public Schools COVID Case Reporting
Please utilize this form to report a positive case for a current Simsbury student or staff member to our nursing and administrative staff.  This information will be handled confidentially and you will receive a follow up email (or phone call as requested) acknowledging your submission once it is reviewed.  We appreciate your support.

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Email *
Is the person you are reporting a student or staff member? *
What is the last name of the individual testing positive? *
What is the first name of the individual testing positive? *
What school does the individual attend? *
Grade of Student (if you are not a student write N/A) *
Name of person reporting case *
Relationship to individual testing positive *
Best phone number to reach individual reporting the case *
Date individual tested positive *
MM
/
DD
/
YYYY
What is the vaccine status of the individual? *
What kind of test was utilized? *
What was the last date the individual attended school in person? *
MM
/
DD
/
YYYY
Does the individual have any symptoms? *
Please list any symptoms below: *
When did symptoms begin? *
MM
/
DD
/
YYYY
Does the individual participate in any school-sponsored extracurricular activities or sports? If so please list below.
Would you like a call back to discuss any questions you may have? *
Thank you.
We appreciate you reporting the case listed above.  Once reviewed you will receive an email with return to school information.  For any immediate questions please contact the school nurse via phone or contact your medical provider.

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