This is the Form used for “COVID-19 CLOSE CONTACT NOTIFICATION FOR SCHOOLS”

COVID-19 CLOSE CONTACT NOTIFICATION FOR SCHOOLS
_________________________________________ _________________________________________
(Name of Close Contact) (Name of School)
You have been identified as a close contact to a person with COVID-19 infection at our school.
Per Hawai’i State Department of Health guidance, you must remain at home in quarantine for 101 days
after your last contact with the person with COVID-19.
You can return to school on __________________, if both conditions are met:
(DATE)
1. 10 days have passed since your last contact with the person with COVID-19 infection
and
2. You do not have symptoms.
Exception: If you are fully vaccinated2 and asymptomatic, you do not have to quarantine and can
return to school. You should get tested in 3 to 5 days.
Public Health Recommendations
• Get tested for COVID-19.
o Find testing locations at https://health.hawaii.gov/coronavirusdisease2019/testing-locations/
o You must remain at home in quarantine even if your COVID-19 test is negative.
o You may need to contact your healthcare provider for a testing referral.
• Monitor your health.
o Contact your healthcare provider, if necessary.
o For medical emergencies, call 911 and inform dispatcher you have been exposed to COVID-19.
• While in quarantine, stay away from others in your home, if possible (e.g., separate bedroom,
bathroom, do not eat meals together), in case you develop COVID-19 infection.
• For more information, visit https://health.hawaii.gov/coronavirusdisease2019/resources/schoolguidance/ for additional guidance on the following topics:
What to Do If You Have Been Tested for COVID-19
Identifying and Talking to Your Close Contacts
Home Isolation and Quarantine Guidance for Schools
COVID-19 Home Care Guide
• If you have questions about quarantine, please call the Hawai`i State Department of Health at
the telephone numbers listed below.
_________________________
1 Quarantine is 14 days for close contacts living or working in congregate settings, including if there are household members
who work in congregate settings (e.g., correctional facilities).
2 People are fully vaccinated 2 weeks after their second dose in a 2-dose series, such as Pfizer-BioNTech, Moderna, and
AstraZeneca, or 2 weeks after a single-dose vaccine, such as Johnson & Johnson’s Janssen vaccine. If you do not meet these
requirements, regardless of your age, you are not fully vaccinated.

Updated September 14, 2021
HAWAI’I STATE DEPARTMENT OF HEALTH TELEPHONE NUMBERS
Island Hours Contact Telephone Number
O’ahu M-F 7:45 am-4:30 pm Disease Reporting Line (808) 586-4586, Option 4 for schools
(808) 587-6845, Option 4 for schools
Maui
Moloka’i M-F 7:45 am-4:30 pm Maui District Health Office (808) 984-8213 (School Liaison)
Lanai
Kauai M-F 7:45 am-4:30 pm Kauai District Health Office (808) 241-3387
Hawai’i (Hilo) M-F 7:45 am-4:30 pm Big Island DHO (Hilo) (808) 796-0098
Hawai’i (Kona) M-F 7:45 am-4:30 pm Big Island DHO (Kona) (808) 796-0098
After Hours/Weekends/Holidays
O’ahu (808) 600-3625
Neighbor Islands (800) 360-2575,
toll-free number