Dawson Health Screening
Email address *
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): *
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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