Transition Services Illness Reporting Form

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INSTRUCTIONS:

1. Please call the attendance line at 303-347-3449 if your student is unable to attend school.
2. Only complete this form if you are reporting an illness.

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 the onset of new symptoms.
3. Please complete a SEPARATE form for EACH student in your household.

4. If your student has been exposed to Covid-19, but is showing NO symptoms, they may attend school.
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 *

JJJJ

Is your student experiencing any of the following symptoms? PLEASE NOTE: If your student's symptoms all resolve within 48 hours, they may return to school. 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. Your student will need to remain home for 24 hours after the last episode of vomiting or diarrhea. For more information about testing refer to:

https://www.arapahoegov.com/2293/COVID-19

The health assistant may have free home tests to provide also.

Loss of taste or smell-this is considered a critical symptom and your student should be isolated immediately. Contact Tri-County at 303-220-9200 push #2 then #1 for further information.

Fever of 100.4 or higher

Cough

Shortness of breath or difficulty breathing

Chills

Fatigue

Nausea or Vomiting

Diarrhea

Muscle or Body aches

Headache

None

Sonstiges:

Pflichtfrage

What date did the symptoms first begin?

JJJJ

If your student has been or will be tested for COVID-19, indicate date of test.

JJJJ

If a COVID-19 test was done, what were the results? If positive, student should isolate for at least 5 days from date of symptom onset or test date, if asymptomatic. Date of symptom onset or date of test, if asymptomatic, is day 0. If symptoms are improving or gone and student has not had a fever in the past 24 hours, they may return on day 6 and wear a mask around others for 5 additional days.

Positive

Negative

Pending: Please complete this form again when the results of the test are received

Auswahl löschen

If your student has tested positive for COVID - 19 what is their expected return to school date? If unknown, leave blank and you will be contacted by school staff.

JJJJ

If the School Nurse Consultant needs to contact you, please list the best email address.

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