Track and Trace page

Positive Test Form

Please use this sheet for reporting a student’s POSITIVE Covid-19 test result between Friday 18^th December and Wednesday 23^rd December.

A member of staff will contact you to confirm receipt of the form.
Students Full Name*
Student Year Group*
Student Tutor Group*
Name of person reporting:*
Email of person reporting*
Relationship to student:*
Contact details:*
Date of report:*
Time of report:*
Date of first symptom/s:*
Date of Covid-19 test:*
Date of Covid-19 test result: (please provide evidence via info@harrismorden.org.uk)*
Evidence
Do they have siblings/family members in school that they live with:* YesNo
If yes please give details:
Did they travel to school with any other student:* YesNo
If yes please give details:
Close Contact with Students

(other than their year group/class group bubble)

- On way to/from school
- In the playground @ break/lunch
- After school
- Other
Have they had any close contact with other students:* YesNo
If yes please give details:
(Between Friday 18^th December and Wednesday 23^rd December)
Have they had any close contact with any other Academy student/s:* YesNo
If yes please give details: