Covid-19 Staff Questionnaire
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Clarendon Park Primary School
Today's Date *
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Surname *
Name *
Do you have a cough? *
Do you have a sore throat? *
Do you have difficulty breathing? (Shortness of breath) *
Do you feel weak and tired today? *
Have you had close contact within the last 14 days with someone who is suspected to have COVID-19? *
Have you visited a healthcare facility within the last 14 days that has treated patients with COVID-19? *
Have you experienced any problems with tasting food and drinks normally? *
Have you experienced any problems with your sense of smell? *
Have you experienced body aches? *
Have you experienced nausea or vomiting? *
Have you experienced diarrhea? *
Is anyone in your household showing Covid-19 symptoms or awaiting test results?
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Temperature: *
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