Highline Public Schools COVID Positive Case Report

Highline Public Schools COVID Positive Case Report

Updated March 14th, 2022
Reporter Name *

First Name Last Name
Reporter Phone Number

Area Code Phone Number
Reporter Email *
example@highlineschools.org | A copy of your response will be sent to this email.
School/Department *
When School was Notified

Month Day Year
Date Hour Minutes AM/PM Option
Section 1: COVID-19 Case Information
Why are you reporting a positive COVID case? *

Tested POSITIVE for COVID-19 (PCR test) Tested POSITIVE for COVID-19 (Rapid or take-home test) Tested POSITIVE for COVID-19 but unsure of test type PROBABLE Case; Symptomatic close contact (household case)
Name of Person with Confirmed COVID-19 *

First Name Last Name
Role *
Student ID# *
Date of Birth *

Month Day Year
Date
Parent/Guardian Name *

First Name Last Name
Home Phone # *

Area Code Phone Number
Home Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Date of POSITIVE COVID Test *

Month Day Year
When the test sample was COLLECTED, not when results came back.
Did/does this person have any symptoms? *

Yes No
Date Symptoms Began

Month Day Year
Date
Date Infectious Period Began (two calendar days before symptom onset and/or positive COVID test) *

Month Day Year
Will calculate automatically. The infectious period begins two calendar days before symptom onset and/or positive test (whichever came first.)
What symptom(s) did this person have?

Fever or chills Cough Shortness or breath or difficulty breathing Fatigue Muscle or body ache Headache New loss of taste or smell Sore throat Congestion Runny nose Nausea or vomiting Diarrhea
Date Last on District Site *

Month Day Year
If this date is before the start of their infectious period (calculated above), you do not need to complete this report and should only track in site-based COVID tracker.
Section 2: Contact Tracing Basics
Has this person interacted with a positive COVID case in the past 14 days?

Yes No Unknown
Information about potential COVID exposure
Grade *
Teacher(s)
Room Number(s)
Does this student ride the bus? *

Yes No
Bus Information
Bus/route number
Which school-related activities has the student participated in during their infectious period? *

Athletics Clubs 1:1s None
Activity Information
Participation date and activity location
Does this person have family/household close contacts in the district?

Yes No
Family Household Contact Information
Please include full name of contacts and site names
How many close contacts have been identified? *
Close contacts should be listed in your school/department-based tracker.
Link to Notification Checklist
Link to Site-Based COVID Tracker
Comments
Feel free to copy+paste any conversation notes you may have.

Earliest date positive COVID case can return to school:

Month Day Year
Date should autofill based on provided information. The positive case can only return on this date if they test NEGATIVE on or after day 5 of their isolation period.
Date positive COVID case can return to school:

Month Day Year
Date should autofill based on provided information. This date is for people who do NOT receive a negative rapid test on day 5 and/or still have symptoms.
ARCHIVED: Unvaccinated close contacts from school (from the last day onsite) earliest date of return:

Month Day Year
Date should autofill based on provided information.
Questions or concerns for the COVID team
Should be Empty:

Highline Public Schools COVID Positive Case Report

Section 1: COVID-19 Case Information

Section 2: Contact Tracing Basics