STUDENT HEALTH SCREENING
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SELECT YOUR NAME BELOW. If you do not see your name, then select "Other" and type in your name. *
ANY PERSON WITH A TEMPERATURE OF 100.4 OR HIGHER (FEVER) WILL BE DENIED ACCESS. HAVE YOU HAD ANY SIGNS OR SYMPTOMS OF A FEVER IN THE PAST 24 HOURS SUCH AS CHILLS, SWEATS, FELT "FEVERISH" OR HAD A TEMPERATURE THAT IS ELEVATED 100.4F OR GREATER? *
DO YOU HAVE ANY OF THE FOLLOWING SYMPTOMS? COUGH, SHORTNESS OF BREATH OR CHEST, TIGHTNESS, SORE THROAT, NASAL CONGESTION/RUNNY NOSE, MYALGIA (BODY ACHES), LOSS OF TASTE AND/OR SMELL, DIARRHEA, NAUSEA, VOMITING, FEVER/CHILLS/SWEATS *
HAVE YOU TRAVELED INTERNATIONALLY OR OUTSIDE OF STATE IN THE LAST 14 DAYS? OR, HAVE YOU HAD ANY CLOSE CONTACT IN THE LAST 14 DAYS WITH SOMEONE WITH A DIAGNOSIS OF COVID-19? *
HAVE YOU TRAVELED TO ANY OF THESE PLACES? Alaska, Colorado, Connecticut, Delaware, District of Columbia, Florida, Indiana, Maryland, Massachusetts, Michigan, Minnesota, Nebraska, New Hampshire, New Jersey, New York, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Puerto Rico, Rhode Island, South Carolina, South Dakota, Vermont, Virginia, Washington, West Virginia, or select  Other to type the COUNTRY *
PLEASE PRESS THE PURPLE SUBMIT BUTTON TO COMPLETE THE HEALTH SCREENING. THANK YOU. IF YOU ANSWERED "YES" TO ANY OF THE QUESTIONS, PLEASE SEE THE PRINCIPAL. CLICK THE PURPLE SUBMIT BUTTON BELOW.
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This form was created inside of Youth Connection Charter School.