VCES COVID-19 Exposure Reporting / Informes de exposición VCES COVID-19

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Please remember that you only need to fill out this form if you are reporting a Covid-19 exposure.

Are you a:*

Answer required for "Are you a:"

VCES staff member

VCES community member (parent/guardian)

Staff member/Parent/guardian first and last name:*

Answer required for "Staff member/Parent/guardian first and last name:"

Staff member/Parent/guardian email address:*

Answer required for "Staff member/Parent/guardian email address:"

Staff member/Parent/guardian cell phone:*

Number Required

Student first and last name:*

Please answer "N/A" if you are a VCES staff member.

Answer required for "Student first and last name:"

Student grade level:*

Answer required for "Student grade level:"

1st

2nd

3rd

4th

5th

Not applicable as I am a VCES staff member.

Date of last contact with Covid-positive individual:*

Answer required for "Date of last contact with Covid-positive individual:"

Is this person a member of your household?*

Answer required for "Is this person a member of your household?"

Yes

Please list any siblings at VCS schools (VCES or VCMS):

Answer required for "Please list any siblings at VCS schools (VCES or VCMS):"

Please fix the highlighted areas below before submitting.