Aidan Montessori School COVID-19 Reporting Form

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PLEASE ONLY SUBMIT FOR CONFIRMED COVID+ CASES

Please submit 1 form per individual. If you need to change something, please email Nurse Lexi directly at l.pollack@aidanschool.org

This form is to be completed by parents or staff to report a positive COVID test result.

Email *

COVID+ Last Name *

COVID+ First Name *

Date of Birth *

YYYY

Student or Staff *

Student

Staff

Class *

Mountain Silverbell - Toddler

Sassafras - Toddler

Dogwood - Primary

Mulberry - Primary

Persimmon - Primary

Redbud - Primary

Magnolia - Lower Elementary

Red Oak - Lower Elementary

Sweet Gum - Upper Elementary

Was the individual symptomatic or asymptomatic *

Symptomatic

Asymptomatic

Date of symptom onset (if applicable)

YYYY

Date of COVID test *

YYYY

Date of COVID test results *

YYYY

Last day COVID+ person was in school or participated in a school activity *

YYYY

Vaccination Status *

Fully Vaccinated (2 doses Pfizer/Moderna, 1 dose of J/J, + 14 days)

Fully Vaccinated + Booster

Not Fully Vaccinated

Have you (staff) or your child (student) been in contact with any other Aidan students or staff members outside of the classroom in the 48 hours before the onset of symptoms or testing positive, whichever came first? *

Yes

If yes, which Aidan community members were you (staff) or your child (student) been in contact with outside of the classroom?

Please provide a brief description of what happened. (Why did you test, do you know how you got it, etc.) *

Send me a copy of my responses.

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