STAFF Reporting COVID-19 Positive Status
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Email *
First Name *
Last Name *
School/Location (Check all that are appy) *
Required
What is your position/working assignment  for WW-P *
Today's Date *
MM
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DD
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YYYY
Reason for concern *
If symptomatic, date symptoms began
MM
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DD
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YYYY
If a COVID test has been conducted, what was the date of the test?
MM
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DD
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YYYY
Last date physically present in District *
MM
/
DD
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YYYY
Email address of building principal
Email address of supervisor
Best phone number to reach you (###) ###-#### *
Best email address to reach you *
Any additional pertinent information
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