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Positive COVID Test Result
Please complete the following details as per DET requirements and thank you for your assistance.
Please ensure that once you have completed this form you report the positive case to DHS for further support.
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* Indicates required question
Your name
*
Your answer
Contact number
*
Your answer
email address
*
Your answer
Child's First and Last Name
*
Your answer
Child's Date of Birth
*
MM
/
DD
/
YYYY
Child's Class/ home group. e.g; 4AC or PAB
*
Your answer
Did they attend OSHC whilst possibly infectious?
*
Yes
No
Symptoms
*
Symptomatic
Asymptomatic
Required
Symptoms Onset Date (if symptomatic)
MM
/
DD
/
YYYY
Test Type
*
RAT
PCR
Date of positive test
*
MM
/
DD
/
YYYY
Where they possibly at school whilst infectious?
*
Yes
No
Unsure
Exposed/ infect outside of school
*
Yes
No
Unknown
Please provide any further details that may be relevant.
Your answer
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