Harbor School Daily Covid-19 Health Screening AY 2021/2022

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Please complete this form in the morning prior to dropping your student off on campus. If you answer "yes" to any of the required questions about symptoms or exposure, please keep your child at home and contact the school for further guidance around when your child can return to school.

Email *

Student Name (Last, First)

In the last 72 hours, have you had a fever of 100.4 or higher ?

Yes

Clear selection

In the last 72 hours, have you experienced any of these symptoms: (please check any that you have experienced)

Coughing

Runny/stuffy nose (not connected with seasonal allergies)

Sore throat

Chills

New loss of taste or smell

Nausea, diarrhea or vomiting

Muscle or body aches

Unusual fatigue

Has your student taken a fever reducing medication in the last 24 hours?

Yes

Clear selection

In the last 72 hours, has your student had close contact (within 6 feet of an infected person for at least 15 minutes) with a person with suspected or confirmed COVID-19?

Yes

Clear selection

In the last 72 hours, has your student had close contact (within 6 feet of an infected person for at least 15 minutes) with a person under quarantine for possible exposure to SARS-CoV-2?

Yes

Clear selection

My child took a Covid-19 rapid test this morning. *

Yes

What were the results of the test? *

Positive

Negative

N/A

Parent Signature (Last Name, First Name)

Submit

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