Covid Contact Information 2023

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Date reporting *

YYYY

Campus Facility or Department *

Staff Type - Do NOT report students here!!!! *

Teacher

NTP

Paraprofessional

Classified - biweekly

FIRST NAME *

Last Name *

Gender *

Female

Male

Prefer not to say

Other:

Employee ID number

Date of Birth *

YYYY

Phone Number *

Last date on campus *

YYYY

Symptom onset date

YYYY

Lab provided Yes or No copy to Dustin.garza@ecisd.us *

Yes

Unknown

Date of test?

YYYY

Test result *

Positive

Were you sent home by ECISD Nurse? *

Yes

Have you been vaccinated for Covid-19? *

Yes 2 doses

Yes with Booster

Single dose J&J

Other vaccine not listed

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