Vejar Health Screen Form
A health screening must be completed by the parent before dropping off the student to class.
Email address *
Student Last Name 學生姓
Student Last Name 學生名
Student ID# 學生號#
Grade 年級
Student: Are you experiencing any symptoms such as current or recent fever (100.4° or higher), chills, cough, shortness of breath or respiratory illness, sudden lack of taste or smell, or sudden onset of unexplained gastrointestinal illness? * 學生 :您現在或最近是否有以下症狀,發燒(100.4°或以上),發冷,咳嗽,呼吸急促或呼吸道疾病,失去味覺或嗅覺,或有突發的無法解釋的胃腸道疾病? *
Clear selection
Student: Have you been in close contact** with any person who has been infected with COVID-19 or suspected to be positive with COVID-19 within in the last 14 days? ** CLOSE CONTACT is defined as: Being within approximately 6 feet of a COVID-19 case for a prolonged period of time; close contact can occur while caring for, living with, visiting, or sharing a healthcare waiting area or room with a COVID-19 case or having direct contact with infectious secretions of a COVID-19 case (being coughed on). * 學生:在過去的14天內,您是否有密切接觸到感染了COVID-19的人? **密切接觸的定義為:與COVID-19病例在6英尺的範圍内長時間相處; 密切接觸也可發生在照顧,一起居住,探訪,或與COVID-19病例一起在醫療候診區或房間時,或直接接觸到COVID-19病例的傳染性分泌物(咳嗽)。*
Clear selection
Are you currently waiting for the results of a COVID-19 test? 您当前是否在等待 COVID-19 测试结果? *
If you have answered "yes" to the previous two questions, please do not enter the school site, return home, and contact the coordinator Mrs. Elisabeth Jones to report your child's absence. 如果您對前兩個問題有回答“是”,請不要進入校區,請返回家中,並與負責人Mrs. Elisabeth Jones 聯繫。
Parent/ Guardian 家長/監護人:
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