RBMS Student Health Self-Screening Checklist
Students MUST complete the COVID-19 checklist each day before coming to campus.
CHECKLIST UPDATED September 1st, 2020
Student Last Name
Student First Name
Student's Grade Level
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.
Yes and I need to stay home.
No, I am not experiencing any symptoms.
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.
Send me a copy of my responses.
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