Positive COVID-19 Report
Please fill out the form below to report a Wissahickon staff or student positive COVID-19 case.  This includes individuals that tested positive or have been in close contact with a positive and have symptoms.
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Email *
Please include name of the positive individual *
Student or Staff *
School *
Grade *
Parent/Guardian Name: If applicable, write N/A if not. *
Phone Number *
Symptoms: Did the positive individual experience any signs/symptoms? *
Symptom Start Date
MM
/
DD
/
YYYY
Is the positive case vaccinated? *
Vaccination Dates: If vaccinated, please list vaccine dates below.
Date of First Dose
MM
/
DD
/
YYYY
Date of Second Dose
MM
/
DD
/
YYYY
Date of Third Dose
MM
/
DD
/
YYYY
COVID Test Taken: Has a COVID test been collected? *
COVID-19 Test Date
MM
/
DD
/
YYYY
Last Date Attended: Last date positive individual attended WSD class or activity. *
MM
/
DD
/
YYYY
Known Close Contacts at WSD: Are there any known close contacts at WSD (please include WSD siblings, other WSD children and/or WSD staff)? *close contact defined as any individual with OR without a mask who was within 6 feet of a positive person for at least 15 consecutive minutes starting from 2 days before symptoms. If positive person is asymptomatic, starting 2 days before COVID test collection. *
WSD Household Close Contacts: (Provide Names, Grades, Schools and Last Date of contact. Please include whether complete isolation from the positive individual can be maintained for each WSD student/staff member)
Sports or Extra Curricular Activities: If you participate in any WSD sports or extra curricular activities, please notify your coach or group leader.
Reporting Multiple Cases?  Please complete a separate form if you are reporting multiple positive cases in your home.
A copy of your responses will be emailed to the address you provided.
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