Staff Online Contact Tracing Form
First Name
Last Name
Date of Birth (mm/dd/yyyy):
Email Address
Primary Building where you work
Select Primary Location
District Admin
Technology
OMT
Aux Sable
Bonnie McBeth
Central Elementary
Charles Reed
Creekside
Crystal Lawns
Drauden Point
Eagle Pointe
Elizabeth Eichelberger
Freedom
Grand Prairie
Heritage Grove
Ina Brixy
Ira Jones
Indian Trail
John F. Kennedy
Lakewood Falls
Liberty
Lincoln
Meadow View
Plainfield Academy
Plainfield High School - Central Campus
Plainfield East High School
Plainfield North High School
Plainfield South High School
Ridge
River View
Thomas Jefferson
Timber Ridge
Walker's Grove
Wallin Oaks
Wesmere
Additional buildings where you may work:
Aux Sable MS
Eichelberger ES
Liberty ES
Ridge ES
Bonnie McBeth LC
Freedom ES
Lincoln ES
River View ES
Central ES
Grand Prairie ES
Meadow View ES
Thomas Jefferson ES
Charles Reed ES
Heritage Grove MS
Plainfield Academy
Timber Ridge MS
Creekside ES
Indian Trail MS
Plainfield Central HS
Walker's Grove ES
Crystal Lawns ES
Ira Jones MS
Plainfield East HS
Wallin Oaks ES
Drauden Point MS
John F Kennedy MS
Plainfield North HS
Wesmere ES
Eagle Pointe ES
Lakewood Falls ES
Plainfield South HS
Ina Brixy
District Admin
OMT
Technology
Position/Title:
Main Contact Phone #
Home Address:
City:
State:
Zip:
County (Will, DuPage, Grundy, etc.):
What was your last day of attendance in a District building? (mm/dd/yyyy)
Have you been diagnosed with COVID-19, have you been in close contact with an individual 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.
Diagnosed
In close contact with an individual with COVID-19
Date Tested? (mm/dd/yyyy)
Date Diagnosed? (mm/dd/yyyy)
Name of Lab?
Location of Lab?
Were you in close contact with an individual with COVID-19 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 you were in close contact with the individual with COVID-19? (mm/dd/yyyy)
Do you live with the individual(s) diagnosed with COVID-19?
YES
NO
Is there more than one person living in the same household as you who has been diagnosed with COVID-19 or is symptomatic for COVID-19?
YES
NO
Are all individuals that tested positive for COVID able to isolate (stay in a specific "sick room" or area and use a separate bathroom, if available)?
YES
NO
Has you tested positive on a lab-based COVID-19 test in the last 90 days?
YES
NO
Have you ever had symptoms?
YES
NO
If yes, what was the first date of symptoms? (mm/dd/yyyy)
Are you fully Vaccinated for COVID-19? (14 days after a single dose vaccine or 14 days after second shot of a two dose vaccine)
YES
NO
Have you received a COVID-19 booster?
YES
NO