COVID-19 Report Form

Please use this form to document the details of the confirmed COVID-19 case. Please note that all information provided will be treated in strictest confidence and only used for the purposes of complying with Health Department reporting requirements.

Sign in to Google to save your progress. Learn more
Email *
Student First Name *
Student Surname *
Classification of Case *
Required
Nature of Case - Positive Case/Close Contact *
If Student - Name of Teacher/Class/Pastoral Care Group
Date of Positive Test or Commencement of Isolation *
MM
/
DD
/
YYYY
Type of Test (if Positive)
Date Last Attended School/School Event *
MM
/
DD
/
YYYY
Co-Curriculum Activities (select all that apply in the last 7 days)
Residential Suburb of COVID-19 Positive Case/Close Contact *
Postcode of COVID-19 Positive Case/Close Contact *
Parent Email Address of COVID-19 Positive Case/Close Contact
Vaccination Status of COVID-19 Positive Case *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of St Virgil's College. Report Abuse
Google Forms