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OLSOS Health Survey
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Student Full Name and Grade
Review the following questions daily and STAY HOME if the answer is "YES".
Does your child have any of the following symptoms not caused by another condition?
Check if YES
Fever 100.4°F / 38°C or higher
Shortness of breath or Difficulty breathing
Muscle pain or Body aches
Loss of taste or smell
Congestion or runny nose
Nausea or vomiting
Other signs of new illness that are unrelated to a preexisting condition (such as seasonal allergies)
None of the above
Have you been in close contact with anyone with confirmed COVID-19? Close contact means being within 6ft (2 m) of an infected person for 15 minutes or more.
Have you had a positive COVID-19 test for active virus in the past 10 days?
Within the past 14 days, has a public health or medical professional told you to self-monitor, self-isolate, or self-quarantine because of concerns about COVID-19?
If you answered YES to any of these questions, stay home and contact the school.
Phone: (360) 373-5162 Email:
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This form was created inside of Our Lady Star of the Sea Catholic School.