2022-2023 FCCPS Staff/Student Covid-19 Positive Case Reporting Form
Dear Parent/Guardian or Staff Member,

Thank you for reaching out for support. In order to expedite assistance and communication, please fill out this form for each positive COVID-19 case you need to report. This information will be evaluated by our FCCPS Health Team and staff will contact you regarding next steps for returning to school/work.  There is no need to report exposures.

Please remember to report your child absent to your schools attendance line. Staff will need to notify their supervisor as well. 

FCCPS follows the CDC, VDH's, and the FCHD's latest guidance regarding positive cases. This will help us determine a return to in person learning date and help to reduce the spread of COVID-19 including its variants. 

We appreciate your cooperation and support as we all work together to keep our learning community healthy.

Fondly,
Rebecca Sharp, Executive Director of Special Services


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Email *
First Name of Positive Case (Staff/Student) *
Last Name of Positive Case  (Staff/Student) *
Date of Birth for the Positive Case  *
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Parent/Guardian Name (if applicable)
Parent/Guardian or Staff Phone Number *
School or  Primary Work Location *
What grade is your student in?
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If grade Pre-K through 5th, please list Teacher
If staff, please list Job Title
Last date of attendance at school/work or any FCCPS sports/activities. *
MM
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DD
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YYYY
Does your student attend FCCPS Day Care? *
Does your student participate in FCCPS sports or after school activities? Please alert your student's coach or activity leader if applicable. *
First day symptoms started (if applicable)?
MM
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DD
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Please identify any symptoms that you have experienced. *
Required
Date of positive COVID test?
MM
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DD
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YYYY
Please share anything else you wish for the health team to know regarding this positive case.
A copy of your responses will be emailed to the address you provided.
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