Dawson Health Screening
Full name of person completing survey
FIRST name of student, employee, or guest the following data is for
LAST name of student, employee, or guest the data is for:
Student's grade, Faculty/Staff, or Parent/Guest
Attendance at Dawson today. (NOTE: If not coming, after submitting this survey, email details to attendance@ dawsonschool .org):
Coming to Dawson today
Not coming: On vacation
Not coming: Doctor/Dentist/Personal Appointment
Not coming: fever/flu-like symptoms (ex. chills, cough, gastrointestinal issue)
Not coming: non-cold/flu symptoms (ex. earache, pink eye, sprained ankle)
Not coming: Remote learning/work
Not coming: Other
In the past 24 hours, has this individual experienced one of the following symptoms: Fever of 100.4º or greater, new onset cough, shortness of breath/difficulty breathing, new loss of smell or taste?
In the past 24 hours, has this individual experienced a new, unexplained onset of one or more of the following: headache, muscle or body aches, sore throat, fatigue, nausea or vomiting, diarrhea?
In the past 14 days, has this individual had close contact with someone with a confirmed diagnosis of COVID19?
If "yes" was answered to any of the above questions, the student/employee/guest is NOT permitted at Dawson. Self-quarantine and/or seek medical attention. This form will be date/timestamped. By hitting DONE below, you agree that the information you provided is current and accurate.
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This form was created inside of Alexander Dawson School.