COVID 19 Positive Test Result Notification Form

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As part of the at-home antigen testing program, all positive test results should be reported to the Johnson School Nurse. Test results are sent to the district for informational purposes only. All results will remain confidential, and individual results will not be made public.

I understand that at any time if my child tests positive for COVID 19, I will keep them home from school, inform the school nurse via this form, follow the current DESE guidelines for home isolation, and quarantine other household members who are unvaccinated or have symptoms of COVID 19 that attend the Johnson School.

I understand that if my child tests positive for COVID 19 they would not continue to participate in testing programs at the school.

Please complete the following information.

Email *

Date of COVID Positive test result *

YYYY

Last name of the individual who tested positive for COVID 19 *

First name of the individual *

Role of the individual (ex, student or staff member): *

Family members or close contacts to the individual who tested positive for COVID 19 who attend the Johnson Elementary School. *

A copy of your responses will be emailed to the address you provided.

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