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POSITIVE COVID-19 Reporting Form
Please complete this form to report a positive COVID-19 test.
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* Verplichte vraag
E-mailadres
*
Je e-mailadres
Name of Positive Individual
Jouw antwoord
Is the positive individual a Staff Member or a Student?
Staff Member
Student
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If reporting for a student, Please provide the Name of Parent/Guardian
Jouw antwoord
Which school does the positive individual attend or work?
*
Marshwood High School
Marshwood Middle School
Marshwood Great Works School
Central Elementary School
Eliot Elementary School
Itinerant Staff, Central Office, Transportation
What date was the positive individual swabbed for the COVID-19 test?
MM
/
DD
/
JJJJ
What date did you receive the results?
MM
/
DD
/
JJJJ
Does the positive individual have symptoms?
Yes
No
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If yes, what date did the individual first start showing symptoms?
MM
/
DD
/
JJJJ
What is the last date this individual was at school or any school event?
MM
/
DD
/
JJJJ
What type of test was performed?
PCR test done by a provider, clinic or other testing site (results took 24-72hrs)
Rapid test done by a provider, clinic or other testing site (results took less than one day)
Rapid Antigen by School Nurse
Rapid Test at Home
I don't know
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Are there any additional details you would like to include?
Jouw antwoord
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Dit formulier is gemaakt in RSU #35.
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