Editing previous response:

Please fix the highlighted areas below before submitting.

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

To translate into a different language, use the translation option located at the top right of the screen.

Para traducir a un idioma diferente, use la opción de traducción ubicada en la parte superior derecha de la pantalla.

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:"

VCMS staff member

VCMS 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 VCMS staff member.

Answer required for "Student first and last name:"

Student grade level:*

Answer required for "Student grade level:"

6th

7th

8th

Not applicable as I am a VCMS 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):"

Confirmation Email

Answer required for "Confirmation Email"