Covid-19 Online Form

Please fill in all fields and if a question is ‘Not Applicable’ write N/A

Child's Name(required)

Child's Surname(required)

Child's date of birth (YYYY-MM-DD)(required)

Child's classroom(required)

Teacher's name(required)

Reporter(required)

Reporters relationship to child(required)

Reporters contact number(required)

Positive COVIDS test-RAT or PCR

Select one(required)

Date of close household contact (YYYY-MM-DD)

Date returning to school (7 days after contact as long as asymptomatic) (YYYY-MM-DD)(required)

Last date attended school (YYYY-MM-DD)(required)

Additional comments

Δ

Current Month