2023-24 Staff, Contractor, and Volunteer COVID Case Report Form 
Hello,

Use this form to report or self-report a staff, contractor, or volunteer/intern COVID case. The form will provide the earliest date to return to work and other information. 

Please be sure to contact your supervisor/school office to let them know of your absence and return date. AAPS Employees: Contact Kenya Glover at HR if you have questions about your absences.

Your information is kept confidential. It is only used for required reporting to the Washtenaw County Health Department.

Updated 10/23
Sign in to Google to save your progress. Learn more
Untitled Title
The following questions refer to the person who has tested positive for COVID-19.
First and last name: *
Email address *
Which building or office do you work in? If you work in more than one building, choose the building you were in most recently. Contractors, see your options at the bottom. *
Is there anything else you would like to tell us about where you worked in the district?
What is your role/position in the school district?
 *
Do you also work in extracurricular activities such as athletics or after school clubs?

If yes, list it here. If no, type "no."
 *
Date symptoms first started: (If no symptoms, enter 01/01/0001). *
MM
/
DD
/
YYYY
Date tested for COVID-19. *
MM
/
DD
/
YYYY
Date last on school grounds: *
MM
/
DD
/
YYYY
WHEN TO RETURN TO ACTIVITIES AFTER TESTING POSITIVE 
Please read carefully
Individuals who test positive must isolate at home for a minimum of 5 days. 

How to count isolation days: 
Day zero = day symptoms began (or if no symptoms, the day of the COVID test). On day 5, if you are fever-free for 24 hours, without fever-reducing medication, and symptoms are greatly improved or gone, you may return to school on day 6.  

We strongly recommend testing on day 5. Stay home until testing negative, or until day 10. You may return to work on day 11. 

Based on the information above on how to count isolation days, what is your earliest possible date to return to school? 

Individuals who return from isolation on days 6-10 are STRONGLY URGED to wear a tight fitting mask indoors. A multilayer surgical, KN95 or N95 indoors is best. 
Do you have any questions or concerns? Please list them here. 
** For questions about use of sick time, please email Human Resources at hr_info@aaps.k12.mi.us. 
Thank you for reporting this COVID case, and we hope that you feel better soon. AAPS employees must notify their supervisor ASAP of their case.


Questions? Contact your school nurse or building administrator.

You may also want to follow up with your health care provider, or visit the Washtenaw County Health Department's COVID website for more information. https://washtenaw.org/coronavirus
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Ann Arbor Public Schools. Report Abuse
Google Forms