Reporting a Positive COVID-19 Diagnosis

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

If a student or a staff member tests positive for COVID-19, please complete this questionnaire to the best of your ability. This will assist us with the contact tracing and county notification process. You will be contacted by the school nurse regarding the return to school date based upon completion of the required isolation period. You will be contacted by either your child's teacher or the appropriate assistant principal regarding virtual instruction during the isolation period.

Email *

Please select one:

Student

Staff Member

Clear selection

Last Name *

First Name *

Date of Birth *

YYYY

Home Address *

Preferred Phone Number for Contact *

Parent/Guardian Name(s) - For Students Only *

Is the student/staff member fully vaccinated? (The county requests this information.)

Yes

Clear selection

Has the student/staff member been exposed to anyone that has tested positive? *

Yes

If yes, was the close contact a household contact?

Yes

Clear selection

When was the last day the individual was in the building? *

YYYY

Please provide the date when symptoms started if the individual is symptomatic.

YYYY

If individual was tested, please provide date when tested.

YYYY

Which tests was administered? *

Rapid Antigen Test (taken at a medical facility)

PCR Test

Rapid Antigen Test (taken at home)

No Test Was Administered. We are presuming a positive diagnosis.

Please list any other OPS students in the household that are close contacts. *

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Oradell Public School. Report Abuse

Forms