SCS COVID-19 Self-Reporting Form
Parents and guardians can use this form to report recent (within the last 14 days) COVID-19 exposures or positive COVID-19 tests to their student's school.
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Are you reporting this form for yourself or on behalf of someone else? *
Are you reporting a COVID-19 exposure or positive COVID-19 test?                                                                       An exposure means that you were a close contact of someone who you know has tested positive for COVID-19 recently. A positive test means you recently took a PCR or Antigen (Rapid) test that was positive, meaning you are infected with COVID-19. *
Student Name *
School Name *
Has the student been on campus in person? *
Has the student been vaccinated? In general, people are considered fully vaccinated 2 weeks after their second dose in a 2-dose series (i.e. Pfizer or Moderna vaccines) or 2 weeks after a single-dose vaccine (i.e. Johnson & Johnson’s Janssen vaccine). People are considered partially vaccinated if they have had at least one COVID-19 vaccine dose, but it has not been 2 weeks since their final dose. *
Date student was last on campus *
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Most recent close contact with COVID-19 infected person: *                                                                              Close contact means you (the student) were within 3-6 feet of the person who tested positive for at least 15 minutes starting from 2 days before they had symptoms or took the COVID-19 test.
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Date notified of exposure:                                                                                                                          This is the date you learned that you had been exposed to someone who tested positive for COVID-19.
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Did this exposure occur in a school or extracurricular setting?
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Is the student experiencing new symptoms after exposure? Symptoms may include fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, or diarrhea.
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