COVID-19 Illness and Exposure Reporting

This illness reporting form will help Monongalia County Schools health staff determine the need for COVID-19 testing, contact tracing, and whether or not you should report for work or school today.

The information you provide may be shared with your school Principal or department administrator, school nurse, and Supervisor of School Health.

If you have not completed a Self-Screening form, please do so or notify your building administrator right away if you will not be attending work or school today.

Basic information and contact

Put a description here

FIRST Name *

LAST Name *

Student/Staff ID * 🛈

Contact Phone *

Contact Email *

Please confirm email *

Are you a: *

Grade(s) (Select all that apply) *

Select all locations where you have been within the last 24 hours. *

Student	Teacher
School Nurse	Other MCS Staff
Other Other

Pre-K	0K	01
02	03	04
05	06	07
08	09	10
11	12

Brookhaven Elementary 203	Cheat Lake Elementary 232
Clay-Battelle High 501	Clay-Battelle Middle
Eastwood Elementary 242	EXCEL Center 011
Mason-Dixon Elementary 236	Morgantown High 502
Mountaineer Middle 301	Mountainview Elementary 233
MTEC 701	Mylan Park Elementary 241
North Elementary 220	Ridgedale Elementary 204
Skyview Elementary 240	South Middle 401
Suncrest Elementary 226	Suncrest Middle 402
University High 503	Westwood Middle 302
Central Office 001	Mountainview Early HeadStart 007
Suncrest Center 025	Maintenance Department 045
Transportation 080	Westover Annex
Dorsey Center	Daybrook Early HeadStart
Other Other