COVID-19 Notification

I am reporting this positive COVID-19 test result

Case Classification*

Positive COVID-19 test confirmed by*

Date test was taken*

Student Name*

First Last

Cohort Group*

Student Class*

Date last attended school*

Student DOB*

Students Gender*

Parent/Guardian Name*

First Last

Parent/Guardian Email Address*

Parent/Guardian Phone Number*

Staff Member Name*

First Last

Staff Member Email*

Date last attended work*

Locations Attended

I was*

Arrangements during isolation period, please select*

Agreement*

I will provide a copy of my PCR test result or Service NSW RAHT confirmation by my return to work date

File*

Max. file size: 8 MB.

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