COVID Self-Screening Assessment-Students
This form MUST be completed each morning before your child comes to school. Please complete for each child if they are attending in-person instruction that day.
Student's First Name *
Student's Last Name *
School *
Does your child have any of the following symptoms that are unexplained or different from your known health conditions?
Has your child been diagnosed with COVID-19 in the past 28 days? *
Does your child live with someone who has been diagnosed with COVID-19 or is still symptomatic in the past 14 days? *
In the past 14 days has your child traveled outside the US or outside Maine, excluding NH, VT, CT, NY, or NJ? *
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