WSD COVID-19 Reporting Form

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WSD COVID-19 Reporting Form - Winter Break

Please use this form to report confirmed positive cases of COVID-19 over the winter break. This form will be monitored by district personnel, including School Nurses. Voicemail boxes in the school offices and nurses' offices will not be regularly checked during the break. This form is only for CONFIRMED positive cases - either by positive COVID test results or diagnosis from a physician. Please fill out one form per individual case.

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이메일 *

Choose School Building *

First Name *

Last Name *

Grade/Assignment *

Was there a known exposure to a positive case? *

Yes

Unknown exposure

필수

Date of Test (If known)

YYYY

Date of Symptom Onset (leave blank if no symptoms)

YYYY

Last date of attendance (in person) at the assigned building.

YYYY

Parent Name (if reporting a student)

Phone Number *

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