CMSD - Employee Quarantine Questionnaire

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If you have tested positive for COVID-19 or have been in contact with someone who has tested positive for COVID-19, please complete the following form.

Note: All information submitted will remain confidential.

Email *

Last Name

First Name

Building

CMHS

CMS

NSIS

CIS

Borland Manor

Hills-Hendersonville

Muse

South Central

Wylandville

Support Facility

Central Office

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What position do you hold within the district (choose only one): *

Teacher

Administrator

Secretary

Parprofessional

Cafeteria worker

Custodian

Bus/van drivers/monitors

Technology department

Maintenance/mechanic

Central Office

Other:

Have you had COVID or quarantined because of an exposure within the past 90 days? *

Yes

Have you had both doses of the COVID vaccine within the past 90 days? *

Yes

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