VCMS COVID-19 Exposure Reporting / Informes de exposición VCMS 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

VCMS staff member

VCMS community member (parent/guardian)

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

Answer Required

Staff member/Parent/guardian email address:*

Answer Required

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

Student grade level:*

Answer Required

6th

7th

8th

Not applicable as I am a VCMS staff member.

Date of last contact with Covid-positive individual*

Answer Required

Is this person a member of your household?*

Answer Required

Yes

Is your child able to fully break contact with the Covid positive individual?*

"Breaking contact" means that your child must have no contact or shared space with the Covid positive individual.

Answer Required

Yes

N/A (I am a VCS staff member.)

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

Answer Required

Please fix the highlighted areas below before submitting.