COVID-19 Screening Form
Please read the questions on the COVID-19 Screening page. By typing your name in this form you are agreeing to ask your child these questions every morning before sending them into school. STUDENTS MUST STAY HOME IF THEY ARE SICK.



Has your child had any of the following symtpoms in the past three days?
Cough
Shortness of breath, Difficulty breathing
Fever or chills
Muscle or body aches
Sore throat
Headache
Nausea or vomiting
Diarrhea
Runny nose or stuffy nose
Fatigue
Recent loss of taste or smell

Has your child been directed to quarantine?

Has your child been indentified as close contact with anyone with Covid 19 or symptoms in the past 14 days?

Has your child traveled anywhere outside the United States in the past 14 days?


Email *
Student's School Account (##JSmith##@epschoolsri.com): *
Child First Name: *
Child Last Name: *
School Attending *
Parent Name: (By submitting your name you are agreeing to ask screening questions DAILY before sending in your child to school) *
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of East Providence School District. Report Abuse