Student COVID-19 Positive Reporting Form

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Please fill out the information if your child has been positively diagnosed with COVID-19.

The information you provide is directed to the Director of Clinic and Health Services and will be kept strictly confidential. It will only be shared with your school nurse, principal and extends to the COVID Response Team members the principal has selected on campus. We will follow all Irving ISD guidelines to communicate the correct information with the school community.

If you child has a positive result, contact the school nurse and send her the confirmed positive result. We are required to report to the Dallas County Health Department all positive results.

Please:
STAY HOME - The student MUST stay at the home and isolate or quarantine.
DO NOT go to friends' homes or other places even if you do not feel sick. You will expose others.
DO NOT come to school if you have a positive COVID-19 result or if you feel sick
DO NOT come to school if your child has been exposed to a positive COVID-19 person/family member
DO NOT send siblings to school if they are in direct contact with the positive COVID-19 individual

DO NOT share your child's personal information - When calling the school, please state you need to speak with the school nurse or the principal regarding your child. We will contact you if we are not available at that time.

It is recommended we work together as a team to provide necessary information to our school staff and all of the parents at the same time. We ask for your child to not share their personal medical condition with anyone on a class zoom until the contact tracing and notifications are properly sent out. This avoids confusion and we want our Irving ISD dashboard to show the correct information without singling out your child. We are required to protect you and your child's medical rights and we need your assistance in making sure this occurs.

Thank you for allowing us to assist you and we appreciate all you do for your child and for the safety and security of all students, teachers and staff in Irving ISD.

Karyn Beauchamp, RN
Director of Clinic and Health Services

Campus Name for student *

Last name of child *

First Name of child *

Student ID number *

Grade of student *

Name of parent/guardian reporting *

Contact Phone Number for parent *

Valid Email address for parent *

Does student attend school all day (in-person) *

Yes

Is the student a remote learner and comes to campus for athletics, band, choir or orchestra classes/practice? *

Yes

Is the student a remote learner only? *

Yes

Last date student was on campus ****Enter the date or enter "none" because they were never on campus *

What class was attended? *

Athletics

Band

Choir

Orchestra

Cheerleading

Drill Team

None

Other:

When did the child begin having symptoms? --------------------------------Enter date OR enter child had no symptoms *

Child has been tested for COVID-19?

Yes

Clear selection

Child was exposed and in direct contact (6ft or less for more than 15 minutes) to someone with confirmed COVID-19?

Yes

Clear selection

When was the child tested for COVID-19?

YYYY

Date positive result received

YYYY

Submit

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