Atalaya Student Daily COVID-19 Screening
Email address *
What is your child's name? (Last, First) *
Who is your child's homeroom teacher? (Laura, Sanchez) *
Has your child had a fever of 100.0° F or higher in the past 24 hours? If yes, stay home, notify school nurse (505-467-4405), and consult your healthcare provider. *
Please take your child's temperature and record it below. *
Has your child experienced any of the following symptoms in the past 24 hours? If yes to any of the below symptoms, DO NOT COME TO SCHOOL. Stay home, notify school nurse (505-467-4405) and consult a healthcare provider. *
Yes
No
Fever or chills
Headache
Cough
Shortness of Breath
Extreme tiredness
Muscle aches
Sore throat
New loss of taste or smell
Nausea, vomiting or diarrhea
New congestion or runny nose
Has your child taken fever-reducing medication in the past 8 hours (Tylenol, Motrin, acetaminophen, ibuprofen, etc.)? *
Has your child been in contact with anyone who has tested positive for COVID-19 in the past 14 days? If yes, DO NOT COME TO SCHOOL. Stay home and notify school nurse (505-467-4405) *
Has your child traveled to a high-risk state in the last 14 days? (View the list of low-risk states here) https://cv.nmhealth.org/travel-recommendations/
Clear selection
Have you been in close contact with visitors from high-risk states, or had any visitors from high risk states stay in your residence in the last 14 days?
Clear selection
By signing your electronic signature on the line below (please type your name), you are stating that all of your above answers are true and your child does not have any symptoms of Covid-19 when reporting to school. Thank you for keeping your Atalaya family safe! *
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Santa Fe Public Schools. Report Abuse