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EXPOSURE to COVID-19 Wyland Elementary School
Please complete this form if your student was exposed to someone who is positive for COVID-19. A COVID-19 exposure is being within 6 feet of a positive person for 15+ minutes outside of school.
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* 表示必填
Name of Person Completing Form
*
您的回答
Phone Number
*
您的回答
Parent email address
*
您的回答
Student's First Name
*
您的回答
Last's Last Name
*
您的回答
Grade
*
Kindergarten
1
2
3
4
5
Date student was last in the school building
*
年
/
月
/
日
Date of Exposure (Considered Day 0)
*
年
/
月
/
日
Is the individual who is positive in your household?
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Yes (see next question)
No
If you answered yes to the question above, is the individual who tested positive able to isolate?
Yes
No-This person's day 5 is your exposed child's day 0
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Is your child exhibiting symptoms of COVID-19?
*
Yes
No
Siblings that were exposed; Name and Grade (if any)
您的回答
Date of scheduled COVID test - if known
年
/
月
/
日
Has your student tested positive for COVID-19 within the past 90 days?
Yes
No
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Is your student fully vaccinated (at least 2 weeks since second dose)?
*
Yes
No
I do not wish to disclose
Not Applicable
If your student is vaccinated, what is the date of their last dose?
年
/
月
/
日
Thank you for completing this form. Have your student stay home from school until we contact you with a return date.
*
I understand that it may take up to one day for someone to contact me.
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