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Positive COVID-19 Case Information Form
**This link is only for individuals who CURRENTLY have a POSITIVE COVID-19 test result.**
If a Covid-19 test was positive, please submit the test results to amanda.,
massey@dcsms.org
. This is very important for quarantine purposes.
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* Indicates required question
First Name of Individual Who Tested Positive
*
Your answer
Last Name of Individual Who Tested Positive
*
Your answer
First and Last name of the individual making this report
*
Your answer
Parent/Guardian email address
*
Your answer
Parent/Guardian phone number
*
Your answer
Is the positive case a student or employee?
*
Student
Employee
If an employee, list job title:
Your answer
If student, please choose grade below.
Pre-K
Kindergarten
First
Second
Third
Fourth
Fifth
Clear selection
Please also list your child's teacher
Your answer
Date last on campus:
*
MM
/
DD
/
YYYY
Does this person have symptoms?
*
Yes
No
If yes, start date of symptoms:
MM
/
DD
/
YYYY
Describe symptoms
Your answer
Date tested for COVID-19 (submit positive case document to
amanda.massey@dcsms.org
)
*
MM
/
DD
/
YYYY
Name of COVID-19 testing facility used:
*
Your answer
Did the positive individual wear a mask to school?
*
Yes
No
If your student rides a bus to or from school, what is their bus number?
Your answer
Someone from the school will contact you as soon as your submission has been processed.
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