Little Tiger Covid Screening Form

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Please complete the daily screen questions each morning (M-F) prior to drop-off. If you have more than one child at Little Tiger, please complete a separate form for each child. Thanks!

Today's Date *

YYYY

Child's Name *

Island community *

Class 1, PreK3

Class 1, PreK4

Class 2

Class 3

Class 4

Do you have reason to believe that anyone in your household has had close contact in the past 10 days with someone with covid-19 symptoms, tested for covid-19, or diagnosed with covid-19 ? *

Yes

Is anyone in your household feeling sick? *

Yes

Does your child or anyone in your household have any of the following symptoms? *

Feeling feverish (chills, sweating, etc.) or a measured temperature greater than 99.6 F

Cough

Difficulty breathing

Sore throat

Muscle or body aches

Vomitting or diarrhea

Loss of taste or smell

Congestion or runny nose

Chills

Fatigue

Headache

Pink Eye

Diarrhea

None of the above

Other:

Required

Electronic Declaration *

I hereby declare that the details here are true and correct to the best of my knowledge.

Required

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