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COVID-19 Positive Case Report Form From Building
Please complete this form after you receive information that a staff member or student has tested positive for COVID-19 or been diagnosed with COVID-19.
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* Indicates required question
Email
*
Your email
Is this a staff or student who is positive?
*
Student
Staff
Last Name of positive staff / student
*
Your answer
First Name of positive staff / student
*
Your answer
What is the primary building for this person?
*
BKE
FES
NKE
PVE
RCI
OMS
OHS
4K
Coach
DO / Pool / Bus Driver / Other
Who called to report the positive case? Please include name, relationship and contact information.
*
Your answer
What other information did the person share? Please include when symptoms started, and date they were tested and the type of exposure if known.
*
Your answer
Does the person have household members in the District? If so, please list names and buildings.
*
Your answer
Was this person in school 2 days before symptoms started or date of test?
*
Yes, start contact tracing.
No, so no contact tracing needed.
Other:
Who will do the contact tracing? If you know, please add the name in other. If not, select that you need someone to.
*
I need someone to contact trace.
Other:
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