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Staff Illness Reporting Form

Staff Illness Reporting Form

Newmeadow is required to report to the Department of Health any suspected or confirmed communicable diseases within the school.  Examples include, but are not limited to, COVID, Flu, RSV, etc.  For a full list please refer to form DOH-389 (1/24) page 2.

Additionally, while individual cases of some diseases are not reportable, a cluster or outbreak of cases of any communicable disease is a reportable event.  A cluster/outbreak includes two (2) or more cases in a classroom or five (5) or more cases throughout the school.  Examples include, but are not limited to, streptococcal sore throat, head lice, impetigo, coxsackie, scabies, and pneumonia.

To help us meet the reporting requirement we ask that you please complete this form.  The reporting of communicable diseases is for tracking purposes only and will be shared with the Department of Health (as needed).  You will not be contacted by the Department of Health.  If you have any questions please contact the health office at 518-899-9235.

Personal Information:

School Information:

Which site do you work at?
Clifton Park
Option 2

Illness Information

If you have a doctor’s note, please forward a copy to Human Resources.

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