Daily COVID Check
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Last Name *
First Name *
03/08/2021 *
MM
/
DD
/
YYYY
Select your school *
Required
Have you taken any medication today or has anyone given you medicine? *
In the last 24 hours have you developed any of the following symptoms (new/different from baseline chronic illness)? Check all that apply. *
Yes
No
Cough
Shortness of breath
Difficulty Breathing
New loss of smell
New loss of taste
In the last 24 hours have you developed any of the following symptoms (new/different from baseline chronic illness)? Check all that apply.
Yes
No
Fever over 99.9
Chills / shivering
Headache
Sore Throat
Runny nose or Congestion
Muscle aches
Fatigue
Nausea
Vomitting
Diarrhea
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