HTCS COVID-19 Screening Form for HTCS Families. May 3, 2021
- Please complete submit one form for before you come to school
- "YOU" refers to your child (you are answering the questions about your child(ren)
- Please submit one form for yourself before you come to school.
Symptom screening can be helpful to determine if you:
- may currently have an infectious illness that could impair your ability to work
- are at risk of transmitting an infectious illness to other individuals on the school site
Required weekly. Stay at home if you answer "yes" to any question.
Who is completing this form?
Parent/Guardian or Staff LAST NAME?
Parent/Guardian or Staff FIRST NAME?
Parent/Guardian FULL NAME?
Student(s) Full Name
HTCS Middle School
1. Do you have any of the following symptoms: Sore throat, cough, chills, body aches for unknown reasons, shortness of breath for unknown reasons, loss of smell, or loss of taste?
2. Do you have a fever over 100.4 degrees?
3. Have you or anyone in your household been in close proximity to someone who has tested positive for Covid-19 or have you tested positive within the last 14 days?
This link will be closed by noon Monday.
Send me a copy of my responses.
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This form was created inside of Holy Trinity Catholic School.