Report an Absence
Report an Absence
This is your form description. Click here to edit.
Date of absence, you may list multiple dates here.
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Student Name
Student Name
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First
Last
Student Number
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Parent Name
Parent Name
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First
Last
Email
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Does the student have new or worsening onset of any of the following symptoms? This includes fever (greater than 100.4º), sore throat, new uncontrolled cough, that causes difficulty breathing (for students with chronic allergic/ asthmatic cough, a change in their cough from baseline); diarrhea, vomiting or abdominal pain; and new onset of severe headache, especially with a fever. Other symptoms listed by the CDC include chills, fatigue/muscle or body ache, new loss of taste or smell, and congestion or runny nose.
If yes, the student cannot come on campus and is required to:
· Stay home for at least ten days since symptoms first appeared,
o AND be fever free for at least 24 hours (without taking medication to reduce fever)
o AND have improvement in other symptoms (cough, shortness of breath).
· OR come back to school after receipt of a negative COVID-19 PCR test (detects the viral genetic material and is obtained by nasal or throat swab) test administered after presenting symptoms. *
Answer to questions above
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Yes, my child exhibits 1 or more of the symptons listed above
No, my child does not exhibit any symptoms listed above
Date Covid symptoms started
Date Covid symptoms started
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MM
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DD
YYYY
Reason for absence
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Upload COVID test results or doctor's note
Attach Files