Bridger K @ Holloday Symptom Tracking Tool

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This form is to should be used to track symptoms of illness AND any reports of COVID-19 exposures and/or positive COVID-19 tests that are reported and observed in students and staff.

Please enter the email address of the person completing this form below:

Email *

1. Full name of person filling out this form

2. Full name of the adult (that was on a district site)/student/staff member you are completing this form for *

3. Please provide the best contact number for the adult/student/staff member/parent/guardian in the event the building nurse needs additional information *

4. Is the person you are completing this form for a *

Adult/Staff member

Student

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