Lindenhurst UFSD COVID Reporting

Please complete one form for each person you are reporting as positive.

Is the positive individual a student or staff member? *

Staff

Student

Confirmation Email *

Student's/Staff's First Name *

Student's/Staff's Last Name *

Which building does your student/staff attend? *

Which grade? *

Job Title *

Date of First Symptoms * +

Date of Positive Test Results * +

Last Day in School * +

Please upload documentation of a positive test result.

Please list the names of any siblings in the household.

School(s) where the siblings attend.