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Run: Communicable Disease Exclusion and Return-to-School Log

Log exclusion decisions and return-to-school clearance for communicable illnesses in one place. This template helps schools document minimal necessary health...

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Submission Notice

Submission Type (required)

Submitted By Role (required)

Student Identifier (required)

Use the school’s internal student ID or another non-sensitive identifier. Avoid entering unnecessary PII.

Submission Date (required)

I understand this form collects limited health-related information for attendance, safety, and compliance purposes. (required)

Yes No N/A

Illness and Exclusion Details

Reason for Exclusion (required)

Exclusion Start Date (required)

Symptom Onset Date

Disease or Condition Name

Enter only if known and necessary for exclusion tracking or public health follow-up.

Exposure Details

Briefly describe the exposure context if relevant. Do not include unnecessary personal or medical details.

Public Health Notified (required)

Exclusion Decision and Guidance

Decision Made By (required)

Decision Date (required)

Exclusion Status (required)

Guidance Source (required)

Decision Summary (required)

Summarize the exclusion decision and any restrictions using objective, observable criteria.

Return-to-School Criteria

Return Criteria Met (required)

Hours Fever-Free Without Medication

Enter the number of hours the student has been fever-free without fever-reducing medication, if applicable.

Date Symptoms Resolved

Provider Clearance Received

Return Restrictions

Return Approved Date

Audit Trail and Follow-Up

Follow-Up Owner (required)

Next Review Date

Audit Trail Notes

Record any key decision points, communications, or documentation references needed for the audit trail.

Supporting Documents

Upload only documents that are necessary for the record, such as a provider note or public health guidance.

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Email (required)

Your name (optional)

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