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Web Submission Form

COVID-19 Report Form for Licensed Child Care Centers & Licensed Family Child Care

Please complete this form weekly for suspected COVID-19 cases in your child care facility. If your child care facility is licensed to serve MORE than 40 children, or you are reporting for a different facility type (school, certified child care, other) please email health.schools.covid19@state.mn.us.

MDH has posted a narrated training, transcript, and slide set with detailed instructions on COVID-19 reporting for school and child care settings: https://www.health.state.mn.us/diseases/coronavirus/schools/reportchange.pdf.

Today's Date

M-D-Y

Reporter's Name

* must provide value

Reporter's Email

* must provide value

County

* must provide value

Facility Type

* must provide value

Licensed child care facility (fewer than 40 children)

Licensed child care facility (greater than 40 children)

Licensed family child care

Certified child care center

K-12 School (public)

Independent/Private school

Charter school

reset

You have indicated that your child care facility has more than 40 children enrolled OR you have selected a facility type (certified child care, school, other) that is not serviced by this form. Please check the box to the right and email health.schools.covid19@state.mn.us for support with reporting your cases.

My child care facility has >40 children enrolled OR I am trying to report cases for a different program type not listed above.

School Name

* must provide value

Childcare Name

* must provide value

Facility Name

* must provide value

Facility City

* must provide value

DHS License Number

* must provide value

Total Student/Child Capacity at Facility

Total Number of Staff (on-site) at Facility

Student/Child Reporting

Please click on the week(s) below for which you would like to enter/update the number of STUDENTS/CHILDREN who reported testing positive for COVID-19 during that date range. This includes positive diagnostic tests done at a school, by a health care provider, or using an at-home test or over-the-counter test. Enter the total number of students/children who reported testing positive for COVID-19 during that week into the adjacent box. If no cases among students/children have been reported, please enter '0' into the adjacent box for that week.

If updating a week that you previously reported for, please enter the cumulative number of students/children who tested positive for COVID-19 within the week. This will overwrite the previous number reported.

05/07/2023 - 05/13/2023

05/14/2023 - 05/20/2023

Staff Reporting

Please click on the week(s) below for which you would like to enter/update the number of STAFF who reported testing positive for COVID-19 during that date range. This includes positive diagnostic tests done at a school, by a health care provider, or using an at-home test or over-the-counter test. Enter the total number of staff who reported testing positive for COVID-19 during that week into the adjacent box. If no cases among staff have been reported, please enter '0' into the adjacent box for that week.

If updating a week that you previously reported for, please enter the cumulative number of staff who tested positive for COVID-19 within the week. This will overwrite the previous number reported.