Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
COVID-19 Student Form
Commit to Wellness Check Each Day
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Your Name
*
Your answer
Were you in close contact, or cared for someone with COVID-19
*
Yes
No
Was your temperature 100.4 or higher or have any of the following, headache, shortness of breath, cough, sore throat, vomiting, diarrhea, abdominal pain, new loss of sense of taste or smell, nausea, fatigue, muscle or body aches.
*
Yes
No
Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Hutsonville CUSD#1.
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report