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Student Online Contact Tracing Form



Complete the form below for the student who is diagnosed with COVID-19 or has been in close contact with an individual with COVID-19. One form must be completed for each student who was diagnosed or has been in close contact with an individual with COVID-19. If a staff member was diagnosed or has been in close contact with an individual with COVID-19, he/she should complete the Staff Contact Tracing form.

Student First Name
Student Last Name
Student ID#:
Date of Birth (mm/dd/yyyy):
Parent Name (full name)
Parent Email Address
Parent Main Contact Phone Number
Student School of Attendance:
Current Grade:


Student Home Address:
City:
State:
Zip:
County (Will, DuPage, Grundy, etc.):


Choose one: Has your child been diagnosed with COVID-19 or has your child been in close contact to someone with COVID-19*?
  

* "Close contact" means an individual who was within 6 feet of a confirmed or probable COVID-19 case for a cumulative total of 15 minutes or more in a 24-hour period 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.

Date Tested? (mm/dd/yyyy)

Type of Test?
  
Date you received the test results? (mm/dd/yyyy)
Name of Lab?
Address of Lab?



What has your child attending in person for in the past week?










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



Does your child currently ride the bus?
  


Does your child live with any other District 202 Staff Members?
  


Does your child live with any other STUDENTS that attend District 202 schools?
  




Date your child was in close contact to someone with COVID-19? (if close contact in school, the date is listed on the letter you received)

Was your child in close contact with someone in District 202 school, athletics, or activities?
  


Did you already receive a letter from the district?
  


Is the student up to date with their COVID-19 vaccine? (Ages 5 and up received two doses of Pfizer/Moderna and students 18 and over have also received their booster)
     




Has your child tested positive on a lab-based COVID-19 test in the last 90 days?
  


Does your child live with the individual(s) diagnosed with COVID-19?
  


Families have 3 options to consider if their child is in close contact with an individual with COVID-19
  



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