Your Name (required)

Your Email (required)

Your Phone Number (required)

Name of the individual(s) (required)
Who may have been infected with COVID-19 or who has become symptomatic, possibly exposing others

Are the affected individual(s) vaccinated? (required)
This helps us determine the best course of action according to current CDC guidelines.

Unit (pack, troop, crew, ship, post) (required)
Of the individual(s) who may have been infected with COVID-19 or who has become symptomatic, possibly exposing others

Address of the individual(s) (required)
Who may have been infected with COVID-19 or who has become symptomatic, possibly exposing others.

County of Residence of the individual(s) (required)
Who may have been infected with COVID-19 or who has become symptomatic, possibly exposing others.

Birthdate of Individual(s) (required)
Who may have been infected with COVID-19 or who has become symptomatic, possibly exposing others.

Email Address of Exposed Individual

Phone Number of Exposed Individual

Relationship to the Scout, Scouter, or parent that is reporting the exposure (required)

Date COVID-19 symptoms manifested (as close as possible) (required)

Suspected place of exposing others, if at a Scout meeting or event (required)

Suspected date of exposing others, if at a Scout meeting or event (required)

Places and dates of other Scouting events within 14 days

Any other pertinent information

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