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COVID-19 Staff Travel Report Form
Use this form to report student and parent travel to level 3 designated countries - Currently: China, Iran, Italy and South Korea (This list is subject to change)
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* Indicates required question
Email
*
Your email
First and last name:
*
Your answer
Best contact number:
*
Your answer
Which Level 3-1 country did you visit?
*
China - Level 3
Iran - Level 3
Italy - Level 3
South Korea - Level 3
Japan - Level 2
Hong Kong - Level 2
Other:
If "other" was selected, which country was visited?
Your answer
Date that you returned from level 3 designated country:
*
MM
/
DD
/
YYYY
Date that you may return to school and is symptom-free (must be no less than 14 days from return date to US):
*
MM
/
DD
/
YYYY
Work location:
*
Your answer
A copy of your responses will be emailed to the address you provided.
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