SWD COVID-19 Reporting Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please use this link if you are a Southwest DeKalb High School faculty, staff member, parent, or student who needs to report a positive COVID status or an exposure from someone who lives with you. A confirmation email will be sent from Mr. Jackson once information has been processed.

Email *

Are you reporting a positive or an exposure case? *

Positive Case

Exposure Case

Which of the following is being reported? *

Student

School-based employee

Please enter the information for the person you are reporting.

Student/Employee Number *

Student/Employee First Name, Middle Initial and Last Name *

Enter the date of birth (MM-DD-YYYY) for the person you are reporting: *

YYYY

Gender *

Please enter the mailing address for the person you are reporting. *

Please enter the city, state, and zip for the person you are reporting. *

Please select the grade level for the student you are reporting

9th

10th

11th

12th

Clear selection

Please select the race/ethnicity of the individual being reported. *

Please enter parent/guardian first and last name of reporting student.

Please enter the parent/guardian phone number of reporting student.

Please enter the parent/guardian email address of reporting student..

Was the reported person in close contact with other people? *

Yes

Are you experiencing any symptoms? *

Yes

Please enter the date when symptoms started (MM-DD-YYYY) *

YYYY

Please enter the student or school-based employee's last date on campus.(MM-DD-YYYY) *

YYYY

Was the student or employee wearing PPE while on campus? *

Yes

Where was the COVID-19 test taken? (If unknown, enter unknown) *

Please enter the date the student or employee tested "positive". (MM-DD-YYYY) *

YYYY

WE DO THE WORK... WE ARE SOUTHWEST DEKALB!

SUPERIOR BALANCE OF ACADEMICS, ATHLETICS, SCHOOL PRIDE AND COMMUNITY ENGAGEMENT

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms