Students Online Contact Tracing Form

Student Online Contact Tracing Form

Please complete the form below for each child in the district who was either diagnosed with COVID-19 or was directly exposed to an individual who was diagnosed with COVID-19.

Is your child currently attending in person or scheduled to return in person within the next two weeks for school, athletics, or activities?

YES NO

Please Select Attendance Type:

In Person School
WILCO
Behind the Wheel
Athletics
Activities

What was the last day the student was in a District building? (mm/dd/yyyy)

Does your child currently ride the bus?

YES NO

Has your child been in any District school buildings for any other reasons in the past week for more than 15 minutes (such as testing)?

YES NO

What was the last day the student was in a District building? (mm/dd/yyyy)

Does anyone else living in your household currently attend District 202 school, activities, or athletics in person?

YES NO

Does anyone living in your household currently work in person at any District 202 buildings?

YES NO

Is anyone living in your household scheduled to return to in person learning in District 202 in the next two weeks?

YES NO

Student First Name

Student Last Name

Student ID#:

Date of Birth (mm/dd/yyyy):

Parent Email Address

Parent Name (full name)

Primary School Student Attends:

Current Grade:

Home Address:

City:

State:

Zip:

County (Will, DuPage, Grundy, etc.):

Has your child been diagnosed with COVID-19 or has your child been directly exposed to someone with COVID-19?
* Direct exposure is close contact with an individual who is positive for COVID-19 during the time they were contagious. Individuals are contagious 2 days prior to having symptoms or two days prior to being diagnosed, if they are asymptomatic.

Diagnosed Directly Exposed

Date Diagnosed? (mm/dd/yyyy)

Name of Lab?

Location of Lab?

Was your child directly exposed in District 202 school, athletics, or activities?

YES NO

Do you know the name of the diagnosed individual (if unsure, leave blank)?

Did you already receive a quarantine letter from the district?

YES NO

Date your child was exposed to COVID-19? (mm/dd/yyyy)

Does your child live with the person who was diagnosed with COVID-19?

YES NO

Is there more than one person living in the same household as your child who has been diagnosed with COVID-19 or is symptomatic for COVID-19?

YES NO

Date of last contact with individual testing? (mm/dd/yyyy)

Date the Individual was tested? (mm/dd/yyyy)

Date symptoms started for the individual? (mm/dd/yyyy)

N/A (No Symptoms)

Does the student currently have any symptoms?

YES NO

If yes, what was the first date of symptoms? (mm/dd/yyyy)