Students & Staff Daily Health Attestation Form
ONLY complete if you or your child WILL be present at school today
Complete 1 for each Compass community member.
If your child will be absent you must call Ms. Diane @ 788-8322, x 12 or she will call you. This is a confidential line where you can report symptoms via voicemail.
Note affiliation here. Only students must be checked next to teacher's names. All adults must check one of the 2 bottom choices.
A Ms. Karen
B Ms. Nicole
C Ms. Elissa
D Ms. Amy
E Ms. Sarah
F Ms. Devin
G Ms. Erica
H Ms. Nikki
I Ms. Harlyn
J Mr. Dave
K Mr. Zack
M Visitor (Volunteer / Parent / Presenter)
L Compass Staffmember
Have you or your child experienced any of the following symptoms in the past three days?
Check any and all symptoms they are experiencing
SHORTNESS OF BREATH OR DIFFICULTY BREATHING
FEVER OR CHILLS
MUSCLE OR BODY ACHES
NAUSEA OR VOMITING
CONGESTION OR RUNNY NOSE
RECENT LOSS OF TASTE OR SMELL
Not experiencing any of the above symptoms.
Check any and all RISK FACTORS that apply to you or your child.
Have been in close contact (less than 6 feet) for 15 cumulative minutes in a 24 hr. period or more with someone with COVID-19 or symptoms of COVID-19 in the past 14 days.
Have been directed to quarantine or isolate by the Rhode Island Department of Health or a healthcare provider in the past 14 days?
Have traveled outside of the 50 United States in the past 14 days
Have traveled to one of the following states in the last 14 days:
HAVE NOT been exposed to any of the above listed risk factors.
I affirm all statements in this form to be answered truthfully
Please state your name below.
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This form was created inside of The Compass School.