Self-Evaluation COVID-19 Screening Test
Please carefully fill out the Self-Evaluation COVID-19 Screening Test to ensure student safety prior to entering the school campus.
SUBMIT ONE PER STUDENT
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Have you or anyone in your household been tested for COVID-19?
Have you experienced any of the following sympotms?
Fever or chills
Shortness of breath or difficulty breathing
Muscle or body aches
New loss of taste or smell
Congestion or runny nose
Nausea or vomiting
Have you or anyone in your household traveled within or outside the U.S. in the past 21 days?
Do you have any reason to believe you or anyone in your household has been exposed to or acquired COVID-19?
Select your child's grade.
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This form was created inside of Our Lady of Mt. Carmel School.