2021-22 End of Isolation Reporting Form (Students)

Harrison Central School District

2021-22 End of Isolation Reporting Form
Students who test positive for COVID-19 are required to isolate for at least five (5) days (regardless of vaccination status). Students may attend school after the 5-day isolation provided:
1. Symptoms have improved
2. Cough/runny nose are resolved
3. No vomiting, no diarrhea and no fever (without fever-reducing medication) for at least 24 hours.
If symptoms persist after day 5, further isolation will be required. Certain symptoms such as loss of taste and smell may persist for weeks or months after recovery and need not delay the end of isolation.

In order for your child to return to school after the 5th day of isolation, please complete this form.
Student Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
School*
Grade Level*
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Email*
example@example.com
Parent/Guardian Phone Number*
Please enter a valid phone number.
The following symptoms need to be improving by the end of the 5-day isolation period.
- Shortness of breath or difficult breathing
- Muscle or body aches
- New loss of taste or smell (may continue beyond 5 days of isolation)
- Fatigue
- Headache
- Sore throat
- Nausea
Have the symptom(s) listed above improved?

YESNO
The following symptoms need to be resolved by the end of the 5-day isolation period.
- Cough
- Runny Nose
Have the symptom(s) listed above resolved?

YESNO
Has your child been free of diarrhea, vomiting and fever (i.e., below 100 degrees) without fever reducing medication for at least 24 hours?

YESNO
Should be Empty:

Harrison Central School District