Report Positive Covid Case for Students
Please use this form to notify Stoller Middle School of a currently enrolled Stoller student with a confirmed positive case.

Please note a staff member from the school may be in contact with you to gather more contact tracing information.

If your student has tested positive for COVID-19, current BSD guidelines require they isolate at home for 10 full days from the date of positive test or symptom onset (whichever occurred first).  Please note that BSD isolation or quarantine timelines may differ from current guidance from the CDC and/or your health care provider.
Sign in to Google to save your progress. Learn more
Email *
Full Student Name *
Student ID # *
Name of person completing form *
Best phone number to contact you? *
Has your student been a close contact of a Covid Positive person?
If Yes, When was last date of exposure?
MM
/
DD
/
YYYY
Has your student had a positive covid test? *
Required
If yes, what date did your student test positive?
MM
/
DD
/
YYYY
Did your student test positive via home test or testing site?
If testing site, please list location.
Has your student experienced symptoms? *
If yes, what date did the symptoms start?
MM
/
DD
/
YYYY
 Please list the symptoms your student has experienced.
What date was your student last at school for class or extracurricular activities? *
MM
/
DD
/
YYYY
Does your student ride the bus? *
If so, when was the last time they rode the bus to or from school?
MM
/
DD
/
YYYY
Does your student participate in school sponsored extracurricular activities? If so, what activities? *
Do you have any other students who attend Beaverton Schools? If so, have you contacted your other student(s) school to inform them of the COVID case? *
Please provide names of any close contact (15 minutes or longer within 3 feet, with or without mask, 2 days before your student tested positive or developed symptoms).  Note: Please include your student's lunch partners, carpool, school related activity or athletic teammates, BSD students/friends seen outside of school.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Beaverton School District. Report Abuse
Google Forms