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Leman COVID-19 Positive Case Report Form
This form allows families to report all of the known information in a systematic way to increase efficiency.
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* Indicates required question
Email
*
Your email
Scholar/ Staff Full Name
*
Your answer
Scholar's Current Grade Level and Homeroom
*
Your answer
What day did symptoms begin?
*
MM
/
DD
/
YYYY
Last Day at School
*
MM
/
DD
/
YYYY
Results of official COVID-19 test
*
Positive PCR test
Positive test administered by a health clinic or at home
Negative
Did anyone in the scholar's home present symptoms before the scholar's symptoms began?
*
Yes
No
Where do you suspect the scholar got COVID?
*
Outside of school
At school
Will you be keeping the siblings home out of precaution or no? Currently, it is not required that healthy individuals are quarantined per Douglas County Health Board.
Yes
No
Maybe
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