Pine Ridge Middle School COVID-19 Reporting for Students/Staff

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Thank you for reporting a close contact, a household contact, symptoms, or a positive case of COVID-19.

Parents: The School Nurse will contact you regarding your child's return to school date.

Staff: Please notify your administrator regarding your return to work and follow guidance at the end of this survey.

You will be asked which one of these you will be reporting:

Close Contact (within 6ft for a cumulative of 15 minutes of a positive case of COVID-19)

Household Contact (student or staff lives with a person who has tested positive for COVID-19)

Positive (student/staff tested positive for COVID-19)

Symptoms: One of these: Fever (temp 100.4 or greater), Shortness of breath or difficulty breathing, Loss of taste or smell, New or worsening cough OR other symptoms associated with COVID-19: Sore throat, Headache, Chills, Nausea or vomiting, Muscle or body aches, Congestion or runny nose, Fatigue, Diarrhea

Please choose from the following: *

Student

Staff

First Name of Student or Staff: *

Last Name of Student or Staff: *

Date of Birth of student or staff: *

YYYY

School or District Location: *

For follow up, indicate your preference of how you would like to be contacted: *

Phone

Phone or Email

Best Phone Number to Reach You: *

Email address (list "none" if none available): *

What are you reporting? *

Close Contact

Household Contact

Positive

Symptoms

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