COVID 19 REPORTING FORM

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In order to stay in compliance with the most recent order from the Department of Health, employees of Pocono Mountain School District should complete this form if they have been exposed to COVID-19. All information will remain confidential.
Thank you for your cooperation.
Mr. W. Bradley Pensyl, Executive Director of Student and Support Staff Services

Have you or a household member been exposed to a person with coronavirus (COVID-19)? *

Yes (If yes, you must fill out the remainder of this form)

Have you or a household member been advised by the PA Department of Health to self-quarantine? *

Yes (If yes, you must fill out the remainder of this form)

Have you or a household member been placed on isolation by the Department of Health. *

Yes (If yes, you must fill out the remainder of this form)

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