FHC Covid Reporting Form

indicates a required answer

1. *	Parent Name

2. *	Email

3. *	Phone Number

4. *	Student name(s)

5. *

Are you reporting a COVID exposure or postive test?

Positive test

Exposure

6. *	What was the date of exposure or positive test?

7. *	Does your student have symptoms? If yes, please describe (fever, runny nose, coughing, shortness of breath, aches, chills, etc.)

8. *

Your plans for testing are:

PCR test ON/AFTER the 5th day from exposure		Not testing, waiting 10 days after exposure
Already tested positive

9.	Please provide us with any other relevant information here: