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KELLOGG MARSH ELEM 2021-2022 Health Reporting Form

TO 𝐀𝐋𝐋 𝐄𝐌𝐏𝐋𝐎𝐘𝐄𝐄𝐒, 𝐒𝐓𝐔𝐃𝐄𝐍𝐓𝐒, 𝐚𝐧𝐝 𝐕𝐈𝐒𝐈𝐓𝐎𝐑𝐒 on any site/location in the District, you are 𝐑𝐄𝐐𝐔𝐈𝐑𝐄𝐃 to 𝐑𝐄𝐏𝐎𝐑𝐓 if at any time you/your student:

- have Covid-like symptoms, or
- have been in close contact with, or exposed to, someone who has tested positive for Covid-19, or
- have tested positive for Covid-19 in the last 10 days or are awaiting a Covid-19 test result.


You 𝐌𝐔𝐒𝐓 𝐑𝐄𝐌𝐀𝐈𝐍 𝐇𝐎𝐌𝐄 and 𝐑𝐄𝐏𝐎𝐑𝐓 it to the District by completing this form so that a District Nurse or Covid Team Member may contact you with directions.

 
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Email *
Are you an Employee, a Student, or a Visitor? / ?Eres empleado o estudiante o visitante? *
Required
First Name of Staff/Student / Nombre del Empleado o Estudiante *
Last Name of Staff/Student / Apellido del Empleado o Estudiante *
Your Phone Number / Tu numero de telephono *
Symptoms / Síntomas
* A new fever (100.4 degrees or higher), or a sense of having a fever.
* A new cough that you cannot attribute to another health condition.
* New shortness of breath that you cannot attribute to another health condition.
* A new sore throat that you cannot attribute to another health condition.
* New muscle aches that you cannot attribute to another health condition, or that may have been caused by a specific activity (such as physical exercise).
* Headache that you cannot attribute to another health condition.
* Fatigue that you cannot attribute to another health condition.
* New loss of taste or smell that you cannot attribute to another health condition.
* Congestion or runny nose that you cannot attribute to another health condition.
* Nausea or vomiting that you cannot attribute to another health condition.
* Diarrhea that you cannot attribute to another health condition.

* Una nueva fiebre (100.4 grados o más), o una sensación de tener fiebre.
* Una nueva tos que no se puede atribuir a otra condición de salud.
* Nueva dificultad para respirar que no se puede atribuir a otra condición de salud.
* Un nuevo dolor de garganta que no se puede atribuir a otra condición de salud.
* Nuevos dolores musculares que no se pueden atribuir a otra condición de salud, o que pueden haber sido causados ​​por una actividad específica (como el ejercicio físico).
* Dolor de cabeza que no se puede atribuir a otra condición de salud.
* Fatiga que no se puede atribuir a otra condición de salud.
* Nueva pérdida del gusto u olfato que no se puede atribuir a otra condición de salud.
* Congestión o secreción nasal que no se puede atribuir a otra condición de salud.
* Náuseas o vómitos que no se pueden atribuir a otra condición de salud.
* Diarrea que no se puede atribuir a otra condición de salud.
One or more of the symptoms listed above is present. / Está presente uno o más de los síntomas enumerados anteriormente. *
Have you/your student been in close contact with a Covid positive (+) person OR tested positive (+) for Covid? / ¿Ha estado usted o su estudiante en contacto cercano con una persona positiva para Covid (+) O dio positivo (+) para Covid? *
A copy of your responses will be emailed to the address you provided.
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