Facility Contact Name * Facility Contact Phone Number * Facility Contact Email Address * Facility Name * Facility Type * - Select -ManufacturingDistributionConstructionConsumer, Retail & ServicesGeneral Office EnvironmentSchools and DaycaresRestaurants and BarsPersonal Appearance and Beauty BusinessesOlder Adult Day CareAdult Day Support or Vocational Habitation ServicesEntertainment, Recreation, and GymsOther Other Facility Type * Facility Address * Facility City * Facility Zip Code * Positive Name * Positive Date of Birth * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year191119121913191419151916191719181919192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021 Positive County of Residence * - Select -AdamsAllenAshlandAshtabulaAthensAuglaizeBelmontBrownButlerCarrollChampaignClarkClermontClintonColumbianaCoshoctonCrawfordCuyahogaDarkeDefianceDelawareErieFairfieldFayetteFranklinFultonGalliaGeaugaGreeneGuernseyHamiltonHancockHardinHarrisonHenryHighlandHockingHolmesHuronJacksonJeffersonKnoxLakeLawrenceLickingLoganLorainLucasMadisonMahoningMarionMedinaMeigsMercerMiamiMonroeMontgomeryMorganMorrowMuskingumNobleOttawaPauldingPerryPickawayPikePortagePreblePutnamRichlandRossSanduskySciotoSenecaShelbyStarkSummitTrumbullTuscarawasUnionVanWertVintonWarrenWashingtonWayneWilliamsWoodWyandot School Contact Type * - Select -StudentFacultyContractor School Address * Please provide the address of the school where the case resides How Does the Positive Case Attend or Work at the School? * - Select -Completely RemoteOn-site (Hybrid or total)Remote Classes / On-Site Sports or Activities If the Student or Staff Participates in On-Site Sports or Activities, List Them Here Leave this field blank