RBMS Student Health Self-Screening Checklist
Students MUST complete the COVID-19 checklist each day before coming to campus.

CHECKLIST UPDATED September 1st, 2020
Email address *
Today's Date *
MM
/
DD
/
YYYY
Student Last Name *
Student First Name *
Student's Grade Level *
Required
1st Period Teacher's Last Name (A Day) *
5th Period Teacher's Last Name (B Day) *
Indicate "Yes" if you are experiencing any of these symptoms that are not normal for you or check "No" if you are NOT experiencing the following symptoms. -Feeling feverish or a measured temperature greater than or equal to 100.0 degrees Fahrenheit -Loss of taste or smell -Cough -Difficulty breathing -Shortness of breath -Fatigue -Headache -Chills -Sore throat -Congestion or runny nose -Shaking or exaggerated shivering -Significant muscle pain or ache -Diarrhea -Nausea or vomiting If you answer "yes," you cannot enter the school building. *
Required
By signing below, you attest that you confidently answered “no” to all symptoms listed above and have a very low risk of carrying or spreading COVID-19. *
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