CADEK Covid-19 Daily Screening
We are asking that all Cadek members (employees, students, and guardians entering the building) complete the survey below on the day of their lesson prior to entering the Cadek building.

If you answer "yes" to any of the health screening questions, you are asked to NOT enter the building and be in contact via phone or email with your instructor or Mark Krawczyk, Cadek Coordinator.
Sign in to Google to save your progress. Learn more
Employee or Student's name (FIRST and LAST) *
Parent/guardian name (if entering the building)
Have you (or your child) had contact with anyone that you know has been diagnosed with COVID-19 in the past 10 days? Contact is defined as being within 6 feet (2 meters) for more than 15 minutes with a person, or having direct contact with infectious fluids from a person with confirmed COVID-19 (for example being coughed or sneezed on). *
Is your (or your child's) temperature ABOVE 100.4 degrees F? (your temperature should have been taken within the last hour) *
Have you (or your child) had a positive-COVID test for active virus in the past 10 days? *
Do you (or your child) have any of these symptoms that you cannot attribute to another condition? *
Yes
No
Fever or chill
Cough
Shortness of breath or difficulty breathing
Fatigue
Muscle or body aches
Headache
Recent onset of loss of taste or smell
Sore throat
Congestion
Nausea or vomiting
Diarrhea
Rash
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Girls Preparatory School. Report Abuse