Female Student Health Screening
Complete this form prior to returning to school for any activities.
Student First Name *
Student Last Name *
Do you have any of the following new or worsening symptoms of possible COVID-19?
Cough *
Diarrhea *
Sore Throat *
Loss of taste or smell *
Headache *
Muscle Pain *
Chills *
Repeated shaking with chills *
Shortness of breath or difficulty breathing *
Feeling feverish or a measured temperature greater than or equal to 100.0 degrees Fahrenheit *
Known close contact with a person who is lab-confirmed to have COVID-19 *
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