Staff Absence Request

Staff Absence Request/COVID Reporting

Name*

Submitting this Form for:*

COVID-19 Reporting Only

Absence Only

Covid Reporting AND Absence

Possible COVID-19 Exposure/Positive Testing:

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.

STAFF ABSENCE REPORTING:

Date(s) For Absence Request, include month, date, year*

Today's Date*

Period of Time*

Type of Absence*

Duties That Need to be Covered (Carline, Bus, Lunch, D-Hall, Detention, Before Care, After Care...)

Lesson Plans Will be Left Where

Additional Info/Comments/Reason for Personal Day Absence

Please leave this field blank.