Student Wellness Form
INSTRUCTIONS:
1. THIS FORM MUST BE COMPLETED BY PARKLAND STUDENTS PRIOR TO PHYSICALLY REPORTING TO SCHOOL, SPORTS PRACTICE OR ENTERING ANY PARKLAND FACILITY.
2. ONLY ONE FORM IS REQUIRED TO BE COMPLETED PER DAY (regardless of the number of buildings you enter).
The Parkland School District is taking proactive steps to protect our schools during this infectious disease outbreak. It is the goal of the Parkland School District during this time period to strive to operate effectively and ensure all essential services are continuously provided and students are safe within our schools. Therefore, beginning July 1, 2020, we are requiring ALL students to review the Return to School information found below and answer the questions in this form.
* Required
What is your Parkland Student Email Address?
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Your answer
What is your First Name?
*
Your answer
What is your Last Name?
*
Your answer
Please indicate if you are playing one of the listed Winter sports or Visual and Performing Arts afterschool program:
*
Choose
Cheerleading
Boys Lacrosse
Girls Lacrosse
Baseball
Softball
Boys Volleyball
Boys Tennis
Swimming
Wrestling
Girls Basketball
Boys Basketball
Indoor Track
Visual and Performing Arts activities (afterschool)
I am currently not participating in a Winter sport or Visual and Performing Arts afterschool program.
Student Health Screening Questions
As of March 20, 2020, the CDC has recommended regular health screenings of temperature and respiratory symptoms upon arrival each day in many places. Since exposure to COVID-19 is not necessarily a medical condition, questions regarding exposure are permissible as per CDC guidelines. Please answer the Student Health Screening Questions 1-6 below to the best of your ability.
1. Since July 2, 2020, Governor Wolf instituted travel advisories that are revised every Friday. Have you traveled to any of the states listed in the Pennsylvania travel advisory linked here:
https://www.health.pa.gov/topics/disease/coronavirus/Pages/Travelers.aspx
or internationally within the last 14 days? If “YES” you may need to quarantine upon your return, for a period of time that will be determined from your conversations with the Human Resources or Nursing department.
*
Yes
No
2. Are you currently experiencing one of the following symptoms (fever-100.4F or higher, cough, shortness of breath, chills, lack of taste or smell) or two or more of these symptoms (headache, congestion, runny nose, sore throat, body aches, nausea, vomiting, diarrhea or fatigue)?
*
Yes
No
3. Have you had any of the above signs or symptoms in the past two weeks?
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Yes
No
4. Take your temperature now. Is it 100.4F or above?
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Yes
No
5. Are you presently caring for or living with someone who has experienced the signs or symptoms of COVID-19 within the past two weeks?
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Yes
No
6. In the last two weeks, have you or someone you live with been under quarantine (not related to travel) for COVID-19?
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Yes
No
If you answer "YES" to ANY of the Student Health Screening questions above, please DO NOT report to school. In addition, follow your schools procedures for being absent from school and provide the best number by which you can be reached in the space below. You will receive a phone call from the building nursing department or the athletic trainers. If you answer "No" to ALL of the Student Health Screening questions, please report to school.
Please use the space below to provide the best number by which you can be reached in case someone from administration needs to contact you.
*
Your answer
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