School Entrance Screening Form
Daily Screening
Full Name *
Affiliation with Union Academy *
Have you had close contact (within 6 feet for at least 15 minutes) in the last 14 days with someone diagnosed with COVID-19, or has any health care provider been in contact with you and advised you to quarantine? *
Since you were last at school, have you had any of these symptoms: Fever, Sore Throat, New Cough, Difficulty breathing, New loss of taste or smell, Diarrhea, Vomiting, or New onset of severe Headache? If anyone in your household has had any of these symptoms you must also quarantine for 14 days. *
In the last 10 days, have you been diagnosed with COVID-19? *
In the last 24 hours have you had a temperature above 100.3 F? *
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