COVID POSITIVE REPORT FORM Your email Is the infected person a Student or Staff member? StudentStaff Student/Employee ID Number Full Name of Positive Individual Birthdate of Positive Individual Home Address of Positive Individual Phone Number Student Grade 6th7th8thStaff Is the Positive Individual Symptomatic? YesNo Date Symptoms Began, if Symptomatic Date of COVID Test Reason for Test Staff SurveillanceClose Contact with Positive PersonSymptomaticTest 2 Stay Last Day on Campus Is the Positive Individual Fully Vaccinated, Including Boosters, if eligible? YesNo Does the Positive Person participate in Athletics or Activities YesNo What Club/Athletic/Activity Does the Positive Individual Participate in? Who are your close contacts at school? (Students you ate lunch with, in class, or during activity). A close contact is someone you were around within 3 feet for longer than 15 minutes while not wearing your mask correctly. Do You have a Sibling or live with anyone else who attends or works at South Valley Prep? YesNo What are the names of Siblings who attend SVP or persons who work at SVP living in the home of the Positive Individual?
