Return to In-Person Learning Health Survey

COVID-19 Exposure

Before returning to in-person learning, Weld RE-1 School District needs to hear from you regarding your experience and/or exposure to COVID-19 since Dec. 19th. Please complete the following short survey. Your answers will only be shared with district and school health staff responsible for COVID-19 tracking. If necessary, a district health staff member will contact you for further information.

Question Title

* 1. Your first and last name

Question Title

* 2. Your contact information

Email Address

Phone Number

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* 3. Enter the first and last names and the school for each of your children.

Child #1

Child #2

Child #3

Child #4

Child #5

Child #6

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* 4. Since December 19th, has anyone in your immediate household been in close contact with someone who tested positive for COVID-19?
See this link for definitions of close contact.

Yes

Maybe (please specify)

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* 5. Since December 19th, has anyone in your immediate household tested positive for COVID-19?

Yes

Return to In-Person Learning Health Survey

COVID-19 Exposure

Question Title

* 1. Your first and last name

Question Title

* 2. Your contact information

Question Title

* 3. Enter the first and last names and the school for each of your children.

Question Title

* 4. Since December 19th, has anyone in your immediate household been in close contact with someone who tested positive for COVID-19? See this link for definitions of close contact.

Question Title

* 5. Since December 19th, has anyone in your immediate household tested positive for COVID-19?

* 4. Since December 19th, has anyone in your immediate household been in close contact with someone who tested positive for COVID-19?
See this link for definitions of close contact.