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Small Covid Incident Response Form 22-23 (confirmed positive)
Covid Incident Response Form 22-23
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* Indicates required question
Email
*
Your email
First Name of Person with a Positive COVID test.
*
Your answer
Last Name of Person with a Positive COVID test
*
Your answer
Please Indicate
*
Student
Staff
E Number or Student Number
*
Your answer
Grade Level
Your answer
Are they fully vaccinated?
*
Yes
No
When is the last time/date that the employee/student was in-person on AISD grounds?
*
MM
/
DD
/
YYYY
Does the student participate in sports?
*
Yes
No
If the employee/student has symptoms, what date did the symptoms start?
MM
/
DD
/
YYYY
What symptoms is the individual experiencing?
*
Your answer
What date did the individual get tested?
*
MM
/
DD
/
YYYY
What type of test was administered?
*
Rapid Antigen
PCR
Where was the test administered?
*
AISD Facility
Community testing site
Doctor's office
At home
Unknown
Other:
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