Powell Illness and COVID-19 Exposure Form
INSTRUCTIONS:
1. Please call the attendance line at 303-734-6310.
2. Only complete this form if you are reporting an illness or a COVID-19 positive case/exposure.
3.If your student is absent for multiple days, you do not need to complete this form again unless there is new information regarding test results or exposures
4. Please complete a SEPARATE form for EACH student in your household.
5. For more information, please refer to the FAQ's: https://littletonpublicschools.net/covid-faqs-parents.
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Student First Name *
Student Last Name *
Student Date of Birth *
年
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月
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日
Which school does your student attend? *
What grade? *
Is your student experiencing any of the following symptoms? Check all that apply.     PLEASE NOTE:  If your student's symptoms all resolve within 24 hours, they may return to school once those symptoms have stayed resolved for 24 hours. If your child had a fever of 100.4 or above, they will need to be fever free for 24 hours without the use of fever-reducing medication. If symptoms do not resolve within 24 hours, your student will need a negative COVID-19 PCR test or 10 days of home isolation before returning to school. For more information, please refer to the FAQ’s https://littletonpublicschools.net/covid-faqs-parents. *
必填
Does your student have any of the following symptoms? Check any that apply. PLEASE NOTE: If your student's symptoms all resolve within 48 hours, they may return to school. If symptoms do not resolve within 48 hours,  your student will need a negative COVID-19 PCR test or 10 days of home isolation before returning to school. For more information, please refer to the COVID-FAQ's for parents at https://littletonpublicschools.net/covid-faqs-parents *
必填
What date did the symptoms first begin?
年
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月
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If your student has been or will be tested for COVID-19, indicate date of test.
年
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月
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If a COVID-19 test was done, what were the results?
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Has your student been exposed to a positive or potentially positive COVID-19 case? Close contact is defined as within a 6 foot distance for a cumulative time of more than 15 minutes. Exposure has to be after the close contact began showing symptoms or during the 2 days prior.
What was the last date of exposure (the last time your student was around a person with COVID-19)?
年
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月
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日
If a health care provider or local public health department gave you a date to end quarantine or isolation, what was that date?
年
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月
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If the School Nurse Consultant needs to contact you, please list the best phone number or email address. *
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