Getting Started
Tools and templates to help you implement a school COVID-19 testing program
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Getting Started Checklist
Getting Consent and Setting Up Your Software
Choosing Specimen Collection Methods
Templates and Examples
Identifying Your Testing Team
Setting Your Testing Schedule
Case Identification
and Contact Tracing
Getting a CLIA waiver for in-school antigen tests
Getting Started Checklist
Want to customize for your program? Download in .docx
Define Your Testing Protocol and Select Your Vendor
Find the right program for your school district and understand the testing options available through that program (e.g., what type of test, how often, students / staff, vendors)
Make contact directly with the vendor to ask questions and set target start date
Connect with your state/local health department to agree on a contact tracing protocol
Identify Your Testing Team (see our guide here)
Identify District Testing Program Manager, School Testing Coordinator, School Outreach Leads, and staff to oversee specimen collection
Complete trainings from vendor to learn how to administer the test and how to use the software to manage your testing roster and public health reporting
School Communications (See our Communications toolkit)
Create your Three Phase Communications Plan
Schedule initial introductory webinars for school staff & community
Create a webpage to answer FAQs about the program
Set a goal for participation in the program and make a plan to meet it
Set up your dashboard and plan for regular communication of test results
Software and Regulatory Onboarding
If you are using a point of care test that requires it, apply for a CLIA Certificate of Waiver. Ask your testing vendor and your State Department of Health for details
Establish standing physician order. State Departments of Health may establish state-wide standing orders or schools can find a local physician to order (see examples below)
Decide whether the testing roster and results will be managed by each school or by the district as a whole
Create a process for collecting consents that includes multiple languages and multiple ways to give consent (e.g., verbally, on paper, in a simple online form)
Testing Logistics and Supplies
Confirm start date with testing vendor
Establish and document testing schedule
Identify testing area(s) at each school and document collection method
Confirm process for transporting specimens to the lab, if needed
Distribute PPE (surgical and N95 masks, eye protection, gloves, gowns), test kits, and supplies (hand sanitizer, sanitizing wipes, tissues) to each school
Identifying your
Testing Team
To support your testing program, it’s important to identify internal, external, or volunteer resources that can take on the responsibilities described below. One individual can take on multiple roles, and in many cases this is recommended. While school nurses tend to make great candidates, a nursing degree or specialized medical training is not necessary to fulfill any of these roles.
At each school district or childcare program, you need:
Testing Program Manager
At each school or site, you need a:
Testing Coordinator & Software Manager
School Outreach Lead
Test Observers & Swab/Saliva Sample Collectors
As a reminder, some programs are small enough that just one person can fill all these roles! Our Identifying Your Testing Team Guide contains detailed descriptions of each role.
Want to customize for your program? Download in .word
Getting Consent and Setting Up Your Software
Why do you need consent?
As with most school programs involving students, you will need to get permission from parents and guardians. Because this is a medical procedure and you’ll need to report positive test results to public health officials, it’s important to get everyone’s consent up front - even educators, staff, and students who are 18 and over.
What consent form should you use?
Please connect with your state Department of Health or your testing vendor for recommendations on standard consent language.
Example: Massachusetts Consent & Opt-In Forms
What specifically do you need consent for?
Administering test
Transmitting student information via the provided technology platform. Public health law requires all test sites to report contact and demographic info for anyone who receives a follow-up test, including: First and last name, Date of Birth, Sex, Race, Ethnicity, Full address, Contact phone/email.
An individual should only submit one form to give consent for repeated school COVID-19 testing.
Parents / guardians of all students should be informed that they may opt out of the voluntary testing program or revoke consent at any time for any reason.
How To Collect Consent:
Four Options for Getting Consent and Building Your Testing Roster
When determining which method(s) to use, consider your community, including: literacy levels, translation needs, email access/responsiveness, preference for phone conversation and verbal consent, preference for paper communication, preference for simple google forms, etc.
Your vendor might have a system to collect consent. These systems vary in quality and ease of use. When in doubt, it’s best to ask if the system can accept a CSV bulk upload. If so, this will allow the school to collect consent in a variety of ways that work for families in the district, compile the consent into a spreadsheet, and upload it to the system on a regular basis.
Best Practices & Tips For Getting Consent
Provide consent forms in multiple languages.
Offer support over the phone for those who need assistance or have questions.
Some districts have found it useful to have a “due date” to encourage sign ups prior to starting testing, but make sure it is clear that students can join the program at any time by submitting the consent form. Nearly all districts find that the size of the program grows over the weeks as word spreads among families that it is safe, gentle, and effective.
Follow-Up, Follow-Up, Follow-Up! Leverage your School Outreach Lead to follow-up with families one-on-one to increase participation rates.
Communicaitons is a key part to gathering consent! Check out our resources in our Communications toolkit and in particular on increasing participation in your testing program.
Toolkit Template: Consent Forms
Click below to view template consent forms for weekly individual PCR tests in multiple languages.
Setting Your Testing Schedule
Your testing schedule will depend on your in-person learning model (everyday, hybrid, etc.) and other unique aspects of your school’s schedule and the geographic location of your schools.
A few helpful things to keep in mind when setting your testing schedule
Don’t forget to coordinate with your testing vendor on testing days to ensure there is capacity at the lab.
In most cases, any trained staff member can administer or observe the test; it does not need to be administered by a healthcare professional. Students in grades 2 and above - and sometimes younger - can self-collect under observation.
Anyone observing a student or staff member self-administering the test should maintain a six-foot distance and wear a face mask and gloves. Anyone administering the test for a student should wear an N95, gown, gloves, and protective eyewear
Testing is quick! It takes less than 30 seconds per student
Example: Weekly Testing Logistics
Our weekly testing logistics template can help you think through when each step in the testing process will happen for each group of students. Download our Weekly Testing Logistics Template to help document your school’s process.
Choosing Specimen Collection Methods
Most school testing programs will use either an anterior nasal swab (“short swab”) that is quick, easy, and painless to administer (It is NOT the deep brain-poking swab) or non-invasive saliva collection in which participants spit directly into the tube.
Youngest learners (pre-K) and students with disabilities: trained staff member assists with collection
The youngest learners and some students with disabilities will have their noses swabbed by a trained staff member or at home by their parents or guardians, or will need close coaching on saliva collection. To decide who can self-swab, many districts say “if you can hold a pencil, you can hold a swab”. It is recommended that staff doing the specimen collection have an N95 or higher respirator, eye protection, gloves, and a gown.
Most students & staff: self collection under observation or at-home
Adults and students grade 2 and above can swab their own noses under observation by a trained staff member. Staff observing self-collection should wear a surgical mask and maintain six feet of distance. There are different models for how to organize swab collection. Many school districts and programs use multiple models depending on schedules, school setup, and age / abilities of students.
How to do a nasal swab
How to self-collect a saliva sample
How to collect a cheek swab sample
Four Specimen Collection Methods to Choose From
There are different models for how to organize sample collection. Many districts use multiple models depending on schedules, school setup, and age / abilities of students, and districts are constantly coming up with new ideas for specimen collection!
Test at the front door | Test during a mask break | Mobile testing cart | At-home collection
Method A
Student testing at front door station as they arrive
8:00am - 8:30am: Testing for most students
Lunch period: Testing for late arriving students
Staff
1 trained observer monitors specimen collection
1 additional staff member records names on spreadsheet and matches to tube by scanning barcode
Testing Rate
180 students can give specimens in the 30 minute morning period.
STEP 1
Staff record name on spreadsheet and scans barcode on tube
STEP 2
Student self-collects under observation
STEP 3
Student sanitizes hands and goes to class
Why this method?
This high school tried testing at lunch, but students didn’t always show up. The testing team found it was more reliable and easier to test students as they arrive in the AM; it also gets specimens out the door to the lab earlier in the day.
Method B
Student testing at mask break
10:00am - 11:00am
Tubes are pre-labeled and organized by classroom
Staff
1 trained observer monitors specimen collection
Testing Rate
Collection takes a matter of seconds per student
STEP 1
Students line up by class
STEP 2
Student self-collects under observation
STEP 3
Student sanitizes hands and goes outdoors for a mask break
Why this method?
The testing team found it was most efficient to have students self-collect at a testing station on their way out the door for a mask break. This way the testing didn’t interfere with instructional time and could be conducted outside. It was also easier to match students to tubes as they arrived at the station as a classroom.
Method C
Student testing in school hallway
9:00am - 11am
Tubes are pre-labeled and organized by classroom
Staff Needed:
1 trained staff member travels corridors with a cart, stopping outside each classroom
Testing Rate:
3-5 minutes per classroom
STEP 1
Cart arrives outside of classroom. Students signed up for testing come into the hallway and line up
STEP 2
One by one, students self-collect under observation. Grades 2+ self-collect; grades K-1 and some students with disabilities may require assistance
STEP 3
Student sanitizes hands and returns to class
Why this method?
Because many elementary school students need assistance with sample collection themselves, this elementary school found that it was quickest and easiest to have nurses travel the corridors with a testing cart, stopping by each classroom for 3-5 minutes to take samples.
Method D
Home collection & drop-off at school
7am - 8am and 11am - 12pm
Drop-off bins are by front door, at office, and in cafeteria
Staff Needed:
1 staff member gathers specimens and packages to send to lab
Testing Rate:
N/A, at home
Why this method?
Home collection minimizes learning time interruption by having students and staff collect the sample at home. Some testing vendors will allow for this and others will not, based on how the test has been authorized.
Keeping School Personnel Safe During Testing
Anterior nasal swabs and saliva tests are not considered to be aerosol generating procedures, but PPE is recommended for people administering or observing the tests simply because, at times, they need to be close to the individual being tested. In this section we describe the types of PPE recommended for different personnel involved in testing.
Personnel actively collecting swabs:
Fitted* N95 or higher respirator (though a surgical mask can be used if a N95 is not available)
Eye protection
Gloves
Gown
*during the public health emergency, and with the wide variety of N95 respirators in use, it is not always possible to perform fit testing. Nurses and health care staff are encouraged to conduct a user seal check to determine if the respirator is being properly worn and should be performed with each use. The user seal check procedure is described here.
Personnel observing swab collection
surgical mask
gloves
All personnel and students should maintain 6 feet of distance and wear masks during swab collection. Any and all staff who are not actively involved in testing should maintain 6 ft of distance and wear a mask.
Getting Your Specimens to the Lab
Unless you are running a point of care test or using comprehensive at-home tests, all specimens must be sent to a testing lab for analysis. Your testing vendor will provide options for getting your pools to the lab, which may include overnight shipping or courier service.
Case Identification
and Contact Tracing
It’s tempting to view finding a positive case as a failure. That is NOT the case. Finding a positive case means your testing program is working. Isolating that positive case means that you have made your school safer for everyone.
In Between a Test and a Result
Because the program tests asymptomatic individuals regularly and not due to any suspected disease, there is no need to quarantine in between a test and the result.
Contact Tracing
There are many different models for contact tracing being deployed in schools nationally. It is important to be in close contact with your state / local health department to determine what role the school will play vs. the health department. Statewide contact tracing resources may also be available. Contact tracing should not be a barrier to implementing a testing program - make sure to contact the public health authorities in your town to explore all options to share this burden.
It’s important to work with your state/local health department to establish a case reporting and contact tracing process for your school testing program that covers:
Who will manage outreach to positive individuals identified through the school testing program
What, if any, follow-up testing is required (This will depend on the type of test used in the testing program)
Who will manage the contact tracing
What defines an in-school close contact
When can a student or staff member who tests positive return to school
Getting a CLIA waiver
A CLIA certificate is required for some kinds of tests, including rapid antigen tests that are not approved for at-home use. Some states have taken a state-wide approach to allow any school building to be covered.
In Massachusetts, for example, the state lab has a CLIA certificate, and the state decided to allow any K-12 site doing antigen tests to be added to the lab’s CLIA certificate-of-waiver as a “temporary site”.
To get included, schools fill out a quick survey with the necessary information as part of their application to the statewide K-12 testing program. Schools agree to conduct the tests per detailed instructions, and then they get the green light to order and perform them.
See the application for coverage here: Application for coverage under a statewide CLIA Certificate of Waiver
Getting Started Templates and Examples
SOPs, Best Practices, and Schedule Plans for Swab Collection
Template: Weekly Logistics Template (pdf)
Example Consent Forms