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2022 COVID-19 Schools/Camp Reporting Form

Please use this secure form to report a COVID-19 positive case affiliated with a school, child care, college/university, camp, sports team, class, club, or other group. Please use one form per positive case. After submitting this survey, the Washtenaw County Health Department will contact you if we require additional information. For questions, please contact 734-544-6700 or health@washtenaw.org.
This question requires a valid date format of MM/DD/YYYY.
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2. Submitter's Information *This question is required.
3. Type of facility *This question is required.
4. Please provide the following information about the location affiliated with the positive case: *This question is required.If your school/camp is not listed please select the Other Not Listed option. Include the name of your school/camp/facility in the last question of the survey and we will add it to the list. You can also email milgromt@washtenaw.org if your school/camp/facility is missing.
Please provide the following information about the positive case:
5. Is the positive case a student/camper/participant, teacher/staff/coach/counselor, or other? *This question is required.
If unknown, enter today's date This question requires a valid date format of MM/DD/YYYY.
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9. Address *This question is required.
10. Contact Information *This question is required.
11. Case information *This question is required.
13. Are there only low-risk exposures (no contact tracing needed) or are there high-risk exposures as well? *This question is required.Most school exposures are low risk: this includes classroom, bus, lunch, and many sports. See school guidance here: https://bit.ly/21K12