General Information

Date Reported:

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School Information

School District Name:(*)
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Name of School:(*)
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Student Enrollment:(*)
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Total Staff:(*)
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Influenza-like illness includes Fever ≥ 100°F and Cough and/or Sore Throat, in the absence of a KNOWN cause other than influenza.

Student Absences

Influenza-Like Illness:(*)
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Other:(*)
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Staff Absences

Influenza-Like Illness:(*)
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Other:(*)
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Totals

Students

Student Absences:(*)
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Student Absentee Rate (%):(*)
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Student ILL Rate (%):(*)
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Staff

Staff Absences:(*)
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Staff Absentee Rate (%):(*)
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Staff ILL Rate (%):(*)
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Report absentee rates of ≥ 10% to the health department immediately at 815-720-4050 or 815-720-4080.

Comments

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