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BCS - CSH - COVID-19 Contact Tracing Report

Student Services
Coordinated School Health
5705 Stage Road
Bartlett, Tn 38134
901-202-0855

 

COVID-19 - Student Contact Tracing Report

Please complete the form below. Required fields marked with an asterisk "*".

 

This form should be completed when a student has tested positive for COVID-19. The purpose of this form is to document which individuals had close contact with the infected individual. Close contact is defined as being within 6 feet of a person with COVID-19 for at least 15 minutes. 

School Location:*
Answer Required

Last 72 Hours of Student Contact

  • All 3 Days are required fields.
  • If any day falls on a weekend and/or holiday, please write this infromation in the box.
  • Please give the date and then list all students and staff members.
  • You can copy and paste.
Day 1:*
Attached File listing the DATE and NAME of ALL INDIVIDUALS that were in close contact with the student. (Example: Jane Doe - 6/30/20, class role, etc.)
Answer Required
or drag it here.
DAY 2:*
Attached File listing the DATE and NAME of ALL INDIVIDUALS that were in close contact with the student. (Example: Jane Doe - 6/30/20, class role, etc.)
Answer Required
or drag it here.
DAY 3:*
Attached File listing the DATE and NAME of ALL INDIVIDUALS that were in close contact with the student. (Example: Jane Doe - 6/30/20, class role, etc.)
Answer Required
or drag it here.
Confirmation Email