Request edit access
Daily Wellness Checklist
Daily Wellness Checklist

Daily Wellness Checks are a VERY IMPORTANT part in keeping you, our student body, and our staff safe. PLEASE complete this Wellness Checklist each day prior to sending your child to school to prevent viruses from spreading rapidly.
REMEMBER, We are all in this together!
Sign in to Google to save your progress. Learn more
Student's Name *
Grade *
Temperature *
Is the student taking any medication to treat or reduce a fever such as ibuprofen (i.e. Advil, Motrin) or Acetaminophen (Tylenol)? *
GROUP A: Is the student experiencing any ONE or more symptom? Fever (100.4 or higher), Cough, Shortness of breath, Difficulty breathing? *
GROUP B: Is the student experiencing any TWO or more symptoms? Sore throat, Runny nose/congestion, Chills, New lack of smell or taste, Muscle pain, Nausea or Vomiting, Headache, Diarrhea? *
Students, please stay home if you have one or more symptom in Group A OR two or more symptoms in Group B OR are taking fever reducing medication. #WeAreInThisTogether!
Clear form
Never submit passwords through Google Forms.
This form was created inside of Rochester Area School District. Report Abuse