COVID-19 Reporting Form

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Should any member of your immediate household (or yourself)

-show COVID like symptoms
-receive a positive PCR or RAT test result,

please refer to this document while filling out this survey.

You will automatically receive a copy of your response. Please use the link in the copy of your response to update your submitted information should it be necessary.

The School Nurse will contact you after receiving the submitted form.

Thank you for your cooperation and understanding.

Sincerely,

Senior Leadership Team

Email *

Name of the person completing this form. *

Select the correct category of the individual for whom this survey is being completed. *

A Saint Maur teacher or external teacher (Private Music or CNED teachers)

A Saint Maur student

A Parent or person (living in the same home)

A non-teaching member of staff

What is the name of the person for which the previously selected category applies? *

If a Saint Maur student, please identify the homeroom. If not a student, please write N/A. *

Select the situation that applies. *

Positive Case

Showing Symptoms

Close Contact with a COVID positive person

Close Contact with someone who is showing COVID like symptoms

Please indicate the date of Day 0. *

YYYY

Provide the date of the PCR or RAT Test (if unsure, please report today's date and when new information becomes available, update using this same Google Form). *

YYYY

For Close Contact cases, please indicate the intended number of days of quarantine before returning to campus (e.g. will be testing on day 2 and 3). *

Please describe in detail the situation with regards to COVID. *

A copy of your responses will be emailed to the address you provided.

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