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COVID-19 Reporting
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* Indicates required question
Email
*
Your email
Name of person completing this form
*
Your answer
Phone Number
Your answer
Are you reporting for a student or a D92 employee?
*
Employee
Student
Name of student(s) or D92 employee being reported
*
Your answer
School
*
Walsh
Reed
Ludwig
Oak Prairie
District
Grade Level
*
Pre K
Ktg
1
2
3
4
5
6
7
8
Teacher
Other:
The individual I am reporting is/has...
*
COVID-19 Positive
COVID-19 Symptoms
No COVID Symptoms but possible contact.
Unknown or unsure
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