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.
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Note affiliation here. Only students must be checked next to teacher's names. All adults must check one of the 2 bottom choices. *
First Name *
Last Name *
Have you or your child experienced any of the following symptoms in the past three days? *
Check any and all symptoms they are experiencing
Required
RISK FACTORS: *
Check any and all RISK FACTORS that apply to you or your child.
Required
I affirm all statements in this form to be answered truthfully *
Please state your name below.
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