EMPLOYEE COVID REPORTING FORM


Thank you for completing this form.  Please contact your primary care physician and follow all of the Return to Work protocols. The general guidance for returning after "close contact" is 14 days of self-isolation.  For employees who have symptoms or test positive, they may return to work after 10 days have passed from symptom onset and at least 72 hours have passed with no fever, without the use of fever-reducing medications and individual has improved with all other symptoms. For questions about leave, please contact robby.fair@hawkinsisd.org.  

For questions about return to work guidelines, please contact the school nurse Natalie.hlavenka@hawkinsisd.org.
Please let us know how we can support you.

Stephanie McConnell,
Superintendent of Schools
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Your Name
Your campus/department
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Describe Situation
Date of First Symptoms
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Date last on campus or with students or staff
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DD
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Preliminary list of people you have had CLOSE CONTACT with on your last date on campus while you were symptomatic?  Close Contact is within 6 feet or more with no face covering or exposed to secretion (cough, sneeze, etc).
Where/How do you believe this exposure occurred?
Contact Information- Please provide a cell phone number or your home number, so the district or your supervisor can check on you throughout your isolation period.
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