COVID-19 Daily Screening for Students
Dear Parents/Guardians: Please complete this mandatory form each day your student attends school in person. A separate form must be completed for each student. This form is not required on remote days.
Student ID Number (This number can be found in the header under your student's name in PowerSchool. It is a unique 6 digit number that is also in your child's Chromebook password.)
Junior/Senior High School
Any of the symptoms below could indicate a COVID-19 infection and may put your student at risk for spreading the illness to others. Please note that this list does not include all possible symptoms and those with COVID-19 may experience any, all, or none of these symptoms.
Please indicate if your student has any of the symptoms/contact exposures listed below. If your student does not have any of the symptoms or contact exposures listed below, please select the last item in the list which states, "My child has no symptoms and/or COVID contact."
Fever (measured at 100.4 or greater within the last 24 hours)
Cough (New or worsening)
Shortness of Breath or Difficulty Breathing
New Loss of Taste or Smell
Chills or shivers
Muscle Aches (not related to injury or exercise)
Headache (a headache that is different from tension or eye strain or migraine or other headaches)
Sore Throat (different from seasonal allergies you may have from time to time)
Nausea or Vomiting
Congestion or Runny Nose (different from seasonal allergies you may have from time to time)
The student has had close contact, within 6 feet of an infected person for a total of 15 minutes or more over a 24-hour period, with a person with confirmed COVID-19.
Someone in the student's household is diagnosed with COVID-19.
The student traveled to a state on NJ’s Travel Advisory List (
My child has no symptoms and/or COVID contact.
If ANY of the symptoms or exposures above are checked, please do not send your child to school and notify the school nurse.
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This form was created inside of Haddon Heights School District.