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MSDH Office of Epidemiology

Please use this survey to report aggregate numbers of total cases, outbreaks and numbers quarantined (students/staff) for your school since the Spring 2022 session began and the new cases, outbreaks and numbers quarantined for the preceding 5 day school week (Monday-Friday). Please designate both the date of the report and designate the range of dates for the week you are reporting.

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* 1. Name of School (Please Spell Out Complete School Name)

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* 2. Name of School District

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* 4. Date School Started/Will Start

Date

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* 5. Please indicate whether your school is currently utilizing in-person learning (traditional), hybrid, or solely online.

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* 6. Which best describes your school's decision on utilizing masks?

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* 7. As of last week, did this school temporarily dismiss on-campus classes and changed to virtual only classes as a result of COVID-19 positive cases and/or quarantines??

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* 8. If you answered yes to the previous question, what was the reason for temporarily transitioning to virtual only classes? 

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* 9. If you answered yes for temporarily transitioning to virtual only classes, please enter the time frame for the transition.

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* 10. Please enter the 5-day school week range in which you are submitting for this report?

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* 11. Name of person completing report/survey

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* 12. Contact phone number of person completing report/survey

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* 13. Email address of person completing report/survey

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* 14. Total number of students enrolled in school

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* 15. Total number of teachers and staff employed in school

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* 16. Total number of positive COVID-19 cases since spring semester began (January 2022)

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* 17. Total number of outbreaks since spring semester (January 2022) began (An outbreak is defined as ≥ 3 cases of COVID-19 in an individual classroom or group sports team, group activity, band, other)

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* 18. Did you have any new COVID-19 cases last school week (Monday-Friday)? If your response is "No," you can now submit the report.

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* 19. Total number of NEW positive COVID-19 cases last school week (Monday - Friday)

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* 20. Does any of the positive cases you listed for last week include staff located in your district office? 

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* 21. Total number NEW outbreaks last school week (Monday-Friday)

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* 22. Location of outbreaks (check all that apply) last school week (Monday - Friday)

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* 23. Please include other information that will be helpful to the Mississippi State Department of Health (MSDH).

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