North Collins CSD Weekly Student Screening
𝐓𝐡𝐢𝐬 𝐬𝐜𝐫𝐞𝐞𝐧𝐢𝐧𝐠 𝐦𝐮𝐬𝐭 𝐛𝐞 𝐟𝐢𝐥𝐥𝐞𝐝 𝐨𝐮𝐭 𝐨𝐧𝐜𝐞 𝐚 𝐰𝐞𝐞𝐤 𝐩𝐞𝐫 𝐬𝐭𝐮𝐝𝐞𝐧𝐭
Please enter your student's North Collins username up until the @. This is the username he or she uses to log into their Chromebook. For example Jane Smith who graduates in 2025 would be: 2025jasmith **You must enter only 1 student per form**
Read the following screening questions and answer below
𝟭. 𝗛𝗮𝘃𝗲 𝘆𝗼𝘂 𝗸𝗻𝗼𝘄𝗶𝗻𝗴𝗹𝘆 𝗯𝗲𝗲𝗻 𝗶𝗻 𝗰𝗹𝗼𝘀𝗲 𝗼𝗿 𝗽𝗿𝗼𝘅𝗶𝗺𝗮𝘁𝗲 𝗰𝗼𝗻𝘁𝗮𝗰𝘁 𝗶𝗻 𝘁𝗵𝗲 𝗽𝗮𝘀𝘁 𝟭𝟰- 𝗱𝗮𝘆𝘀 𝘄𝗶𝘁𝗵 𝗮𝗻𝘆𝗼𝗻𝗲 𝘄𝗵𝗼 𝗵𝗮𝘀 𝘁𝗲𝘀𝘁𝗲𝗱 𝗽𝗼𝘀𝗶𝘁𝗶𝘃𝗲 𝘁𝗵𝗿𝗼𝘂𝗴𝗵 𝗮 𝗱𝗶𝗮𝗴𝗻𝗼𝘀𝘁𝗶𝗰 𝘁𝗲𝘀𝘁 𝗳𝗼𝗿 𝗖𝗢𝗩𝗜𝗗-𝟭𝟵?
𝟮. 𝗛𝗮𝘃𝗲 𝘆𝗼𝘂 𝘁𝗲𝘀𝘁𝗲𝗱 𝗽𝗼𝘀𝗶𝘁𝗶𝘃𝗲 𝘁𝗵𝗿𝗼𝘂𝗴𝗵 𝗮 𝗱𝗶𝗮𝗴𝗻𝗼𝘀𝘁𝗶𝗰 𝘁𝗲𝘀𝘁 𝗳𝗼𝗿 𝗖𝗢𝗩𝗜𝗗-𝟭𝟵 𝗶𝗻 𝘁𝗵𝗲 𝗽𝗮𝘀𝘁 𝟭𝟰-𝗱𝗮𝘆𝘀?
𝟯. 𝗔𝗿𝗲 𝘆𝗼𝘂 𝗲𝘅𝗽𝗲𝗿𝗶𝗲𝗻𝗰𝗶𝗻𝗴 𝗮𝗻𝘆 𝘀𝘆𝗺𝗽𝘁𝗼𝗺𝘀 𝗼𝗳 𝗖𝗢𝗩𝗜𝗗-𝟭𝟵, 𝘀𝘂𝗰𝗵 𝗮𝘀: 𝗙𝗲𝘃𝗲𝗿 >𝟭𝟬𝟬°𝗙 𝗼𝗿 𝗰𝗵𝗶𝗹𝗹𝘀; 𝗖𝗼𝘂𝗴𝗵; 𝗦𝗵𝗼𝗿𝘁𝗻𝗲𝘀𝘀 𝗼𝗳 𝗯𝗿𝗲𝗮𝘁𝗵 𝗼𝗿 𝗱𝗶𝗳𝗳𝗶𝗰𝘂𝗹𝘁𝘆 𝗯𝗿𝗲𝗮𝘁𝗵𝗶𝗻𝗴; 𝗙𝗮𝘁𝗶𝗴𝘂𝗲; 𝗠𝘂𝘀𝗰𝗹𝗲 𝗼𝗿 𝗯𝗼𝗱𝘆 𝗮𝗰𝗵𝗲𝘀; 𝗛𝗲𝗮𝗱𝗮𝗰𝗵𝗲; 𝗟𝗼𝘀𝘀 𝗼𝗳 𝘁𝗮𝘀𝘁𝗲 𝗼𝗿 𝘀𝗺𝗲𝗹𝗹; 𝗦𝗼𝗿𝗲 𝘁𝗵𝗿𝗼𝗮𝘁; 𝗖𝗼𝗻𝗴𝗲𝘀𝘁𝗶𝗼𝗻 𝗼𝗿 𝗿𝘂𝗻𝗻𝘆 𝗻𝗼𝘀𝗲; 𝗡𝗮𝘂𝘀𝗲𝗮 𝗼𝗿 𝘃𝗼𝗺𝗶𝘁𝗶𝗻𝗴; 𝗗𝗶𝗮𝗿𝗿𝗵𝗲𝗮?
*Check “No” if the nature of the symptom (duration, intensity, etc.) is consistent with a pre-existing condition of which you are already aware that is not new, worsening, or different from its usual presentation.
(i.e., seasonal allergies, asthma, sinus, tension or migraine headaches, inflammatory bowel disease, Crohn’s Disease, Lactose Intolerance, Irritable Bowel Disease, Chronic Fatigue Syndrome).
𝟰. 𝗛𝗮𝘃𝗲 𝘆𝗼𝘂 𝘁𝗿𝗮𝘃𝗲𝗹𝗲𝗱 𝗶𝗻𝘁𝗲𝗿𝗻𝗮𝘁𝗶𝗼𝗻𝗮𝗹𝗹𝘆 𝗼𝗿 𝗳𝗿𝗼𝗺 𝗮 𝘀𝘁𝗮𝘁𝗲 𝘄𝗶𝘁𝗵 𝘄𝗶𝗱𝗲𝘀𝗽𝗿𝗲𝗮𝗱 𝗰𝗼𝗺𝗺𝘂𝗻𝗶𝘁𝘆 𝘁𝗿𝗮𝗻𝘀𝗺𝗶𝘀𝘀𝗶𝗼𝗻 𝗼𝗳 𝗖𝗢𝗩𝗜𝗗-𝟭𝟵 𝗽𝗲𝗿 𝗡𝗲𝘄 𝗬𝗼𝗿𝗸 𝗦𝘁𝗮𝘁𝗲 𝗧𝗿𝗮𝘃𝗲𝗹 𝗔𝗱𝘃𝗶𝘀𝗼𝗿𝘆 𝗶𝗻 𝘁𝗵𝗲 𝗽𝗮𝘀𝘁 𝟭𝟰-𝗱𝗮𝘆𝘀
Mark your answer to the above questions
I can answer YES to one or more of the above questions
I can answer NO to ALL of the above questions
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