Staff reporting of positive COVID19 test or quarantine December 23-January3rd 2020-2021

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Please use this form to document staff positive cases of COVID19 or quarantine from 4pm Tuesday December 22nd through 8:00am January 3rd. This form takes the place of calling your school nurse, administrator, or director. All employees - please notify your director/principal if you will miss Monday January 3rd due positive cases or quarantine. Teachers - if you will need a substitute please enter into absence management so PENMAC can have a head start for January 4th.

Staff member's name

Staff member's building(s)/department - if you work in a building please check the box. If you work in a district department, please use the boxes below and not a school.

Lyon

McCulloch

Price

Schofield

Sweeny

Middle School

High School

Transportation

Maintenance

Food Service or Central Office Employee

Tech

STRIPES 360 Employee

Special Education/Federal Programs Office Employee

Other

Date the staff member was last at work

YYYY

Are you in quarantine due to an exposure to a positive case?

Yes

Other:

Clear selection

If you are only in quarantine due to an exposure, please list dates of quarantine.

If you have COVID 19 symptoms, what was the date in which symptoms began?

YYYY

Have you tested positive for COVID 19?

Yes

Clear selection

What was the date of the positive test?

YYYY

Employee phone number

Submit

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