COVID Positive Reporting - Vanderbilt
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*
Required
Name
*
required
First Name
Last Name
Category
*
required
Student
Staff
Date of Birth
*
required
Must contain a date in M/D/YYYY format
Best Email Address Contact
*
required
Best Phone Contact Number
*
required
Grade Level
*
required
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Date test administered
*
required
Must contain a date in M/D/YYYY format
Type of Test
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required
Home Test
Rapid
PCR
Other
Is the person named above symptomatic:
*
required
Yes
No
Date symptoms began:
*
required
Must contain a date in M/D/YYYY format
Last Day in School/Building:
*
required
Must contain a date in M/D/YYYY format
Please list the name and building of any others in the household that attend or work in HHH Schools:
Please upload all documents (Positive Test, Doctor Note, Lab Report, Affirmation, etc). *Home Test Positive Results must be submitted with a means to verify the date the test was administered*
Attach up to 5 files with a maximum size of 20MB
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