COVID-19 School Reporting Form

This form should be used to report a student or staff member who is symptomatic, exposed or positive for COVID-19.

Is this a report about

A studentA staff member

School & Department Location of Staff or Student:

Your Name

First NameLast Name

Your Email

example@example.com

Your Phone Number

Please enter a valid phone number.

Are you completing this form for yourself or someone else?

SelfSomeone else

You are

SymptomaticExposed to a known Covid-19 casePositive for Covid-19Other

Please give details

Symptoms, dates if tested, any close contacts etc.

The person you are reporting

SymptomaticExposed to a known Covid-19 casePositive for Covid-19Other

Please give details

Symptoms, dates if tested, any close contacts etc.

Name of the person you are reporting

First NameLast Name

Phone Number

Please enter a valid phone number.

Student ID (if known)

Number

Parent/Guardian Name

First NameLast Name

Parent/Guardian Phone Number

Please enter a valid phone number.