Staff Absence Request

Staff Absence Request/COVID Reporting

Submitting this Form for:*

If you believe you or anyone in your household has possibly been exposed to COVID-19, or if someone in your household has tested positive, reporting this is required here. Please report in the BOX ABOVE: 1. WHO in the household was possibly exposed or tested positive, 2. DATE of possible exposure or positive test, and 3. HOW possibly exposed. The Nurse will contact you for further info. and with next steps.