Lancaster High - COVID 19 Information Form
EMPLOYEES SHOULD ONLY USE THEIR DISTRICT EMAIL ADDRESS.  If a staff member, employee, student, or visitor has tested positive for COVID-19, reports symptoms of COVID-19, or reports exposure to a person contagious with COVID-19, the administrator or their designee should collect as many details as possible, including:
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Email *
Please indicate your role: *
Work or school location (check all that apply): *
Required
First Name *
Last Name *
Date of Birth (for DHEC Reporting) *
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Phone Number *
Mailing Address *
The employee/student has......(Check the all that apply) *
Required
List the date of your 2nd COVID-19 VACCINE
LEAVE BLANK IF YOU HAVE NOT RECEIVED YOUR 2ND VACCINATION
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For those who have travel outside the U.S., What was the date of your return to the U.S.?  (leave blank if not traveled outside the U.S.)
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List of Symptoms for the employee/student: *
Check all that apply
Required
Date of Employee/Student's First Symptom of COVID
 Leave blank if no symptoms.
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Date of Employee/Student's most recent physical presence in a district facility, school or office, including all locations. *
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Date of possible exposure (leave blank if unknown)
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Date of COVID-19/Coronavirus Test for the employee or student listed above(leave blank if no test)
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If the employee or student was tested, have you received the results? *
Date of Employee/Student’s physical presence in a district facility, school or office including all locations for 48 hours prior to the sample collection for the positive COVID-19 test.
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Please list all individuals or groups the student or employee been in any contact with since the exposure or 48 hours prior to the positive test or first symptom. *
Please list all individuals or groups (include LCSD students or employees) who would be considered a close contact since the exposure or 48 hours prior to the positive test or first symptom.   *
Close contacts are defined as two individuals less than 6 feet apart for 15-minutes or more, with or without a face covering/mask.
Please state any other relevant details and action taken. *
List all LCSD employees and/or students that also live in your home. *
A copy of your responses will be emailed to the address you provided.
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