COVID-19 Event Reporting Form
This form is to be used to provide basic information regarding a reported an exposure, a positive or suspected COVID case and other communicable diseases. Gathering accurate information is critical in order to reduce risk to others and mitigate the spread of viruses. The information you are asked to provide remains CONFIDENTIAL!  Please do not share the following information with other individuals regarding potential cases or close contacts, unless the principal directs you to do so.

All individuals who are determined to have been in close contact with a positive case on campus will be notified and given quarantine instructions as applicable. Juliet Baker, the person receiving this via "healthreporting@centralcatholichigh.org" will report to Danyelle Ramsey and contact a parent for confirmation and follow-up. The counselor also will be notified of a report.  

Thank you, Danyelle Ramsey, COVID-19 Response Team.

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Email *
Full name & title of the person filling out this form *
 Contact phone number of the person filling out this form.  
Source of information: *
Required
Date reported *
MM
/
DD
/
YYYY
Person who initially reported information: *
Required
Student Name *
Grade/Cohort *
Student's Counselor
Date tested (if known)
MM
/
DD
/
YYYY
Date person was last in CCHS building or involved in CCHS-activity, if known.
MM
/
DD
/
YYYY
Please provide additional information regarding possible close contacts or other pertinent info here or via email: healthreporting@centralcatholichigh.org:
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