Monroe County, NY COVID-19 School Reporting Form
School District
Brighton
Brockport
Churchville-Chili
East Irondequoit
East Rochester
Fairport
Gates-Chili
Greece
Hilton
Honeoye Falls-Lima
Penfield
Pittsford
Rochester
Rush-Henrietta
Spencerport
Webster
West Irondequoit
Wheatland-Chili
Other
School Name/Building
School Contact First Name
School Contact Last Name
Contact Email
School Phone #
Type
Student
Faculty/Teacher
Staff (non-teacher)
Volunteer/Visitor
First Name
Last Name
Date of Birth
Parent First Name (if student)
Parent Last Name (if student)
Parent/Staff Phone #
Symptoms Onset Date
Temperature
Loss of Taste
Loss of Smell
Description of Symptoms
If known, please state reason for no test and/or health care provider evaluation
Submit Information