This purpose of this form is to provide an outlet for district employees and parents of students to update Chester County Schools Nursing Services of any exposure or positive test result experience by a student or employee during winter break. A school nurse will contact you to share additional information, including return to school or work dates based on date of test and/or last exposure.

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* 1. Today's Date

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* 2. Is this form being completed for a staff member or student?

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* 3. Name of Staff Member/Student

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* 4. Date of Birth

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* 5. Phone Number

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* 6. E-mail

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* 7. Did the staff member/student test positive for COVID-19?

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* 8. Date of Positive Test

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* 9. Did the staff member/student come into contact with someone who has tested positive for COVID-19?

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* 10. Date of Quarantine

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